Approximately 4.5 million college students nationwide receive health insurance coverage through so-called student health plans (SHP) — insurance that is available to college students — and if progressive advocates get their way, these plans will have to abide by the federal consumer protections in the Affordable Care Act, which prohibit insurers from denying coverage to individuals with pre-existing conditions, rescinding coverage, or placing annual or lifetime caps on benefits. Following an investigation by New York Attorney General Andrew Cuomo, which found that some college plans offer porous coverage that skirs state laws and regulations, youth organizations like Rock the Vote and Young Invincibles sent a letter to White House and the Department of Health and Human Services (HHS) asking regulators to ensure that SHPs abide by the regulatory baseline created in the Affordable Care Act.

The crux of the matter is whether HHS (which has regulatory authority over the plans) classifies SHPs as individual health plans — thereby requiring that they abide by the consumer protections in the law — or limited duration plans, potentially exempting them from the new federal standards. In their letter, the groups argue that the latter approach would “leave these plans virtually unregulated,” “exempt from even the most basic protections”:

Some groups have suggested defining student plans as “short-term limited duration insurance.” However, student plans do not fit into the definition of “short-term limited duration insurance.” Moreover, because this type of insurance is generally considered neither individual nor group insurance, there is a strong argument that such a definition would leave these plans virtually unregulated by the PPACA – a scenario clearly not within the intent of Congress.

Defined as “short-term limited duration insurance,” student health plans would arguably be exempt from even the most basic protections in the PPACA, including the:

- Ban on rescissions;

- Ban on discrimination based on pre-existing conditions;

- Limits on annual and lifetime benefit caps;

- Preventive care requirements;

- Minimum benefits package;

- Medical loss ratio requirements, among others. [...]

Indeed, student plans have not historically been classified as “short-term limited duration insurance,” under HIPAA, the PHSA, or any other federal statutory scheme – nor should they be. Student plans are often offered for a full 12 months. Moreover, they are almost always offered to any student who chooses to stay enrolled in a college or university. Additionally, any partial classification, leaving some shorter-term student plans regulated in this category, would merely encourage all student plan issuers to redefine their coverage as semester-based coverage, giving them a loophole through which to deprive students of important consumer protections. As such, any attempt to call student plans “short term limited-duration” plans would be both inaccurate and potentially detrimental to the well-being of several million students enrolled in them.

The American Council on Education — which represents presidents and chancellors of accredited educational institutions — and several other higher education associations disagree. They’re asking the government to “designate, in regulation, that student health coverage is considered minimum essential coverage under the individual mandate,” but argue that these plans have been traditionally seen as short-term limited duration insurance” and should be classified this way “[t]o avoid unintended consequences.”

“We believe that there is going to be coverage under ACA even under limited duration plans,” Steven Bloom, ACE’s Assistant Director of the Division of Government and Public Affairs told me in a phone interview. “The question is, tell us what they have to comply with under ACA.” The education associations do agree that the SHPs should be “made available to eligible students and their eligible dependents as defined by the policy without regard to health status or pre-existing conditions” and that they should meet the “actuarial standards of the Bronze Plan,” but do not go as far as Young Invincibles in demanding that they be required to meet almost of the requirements of individual health insurance plans.

Along with concerns that the law’s guaranteed issue and guaranteed renewability rules would undermine the plans’ student-only enrollment structure, Banson says that his group is also worried that issues like “pricing and rating” could undermine the policies. The law requires states to “establish 1 or more rating areas within that State,” but SHPs are priced differently, “based on campus population,” Banson told me.

Banson stressed that the higher education associations who signed on to the letter are not advocating against the new consumer protections. Rather they are asking for “guidance for what the rules of the road are” so “schools can understand what their student plans are required to comply with in the Affordable Care Act and what insurance reforms apply to student health plans.” Bloom says that even if these plans are “classified as limited duration plans it still means that students will have to purchase something that satisfied” the minimum benefits requirement under the law and would have to meet federal standards of coverage.

HHS is likely to issue the regulations in the coming weeks.

Outgoing Republican Senator Judd Gregg (R-NH) has penned a Halloween-themed editorial advancing some new myths about the Affordable Care Act, all the while implicitly conceding that Republicans will not be able to repeal the law. “Caught in a cobweb of false promises, the American people were fed a story about how health care reform would insure everyone, allow people to keep their own insurance policies and reduce health care spending while improving quality,” Gregg writes. “Sadly, these were fantasies masquerading as fact. The scary tale that follows needs no skeletons or vampires; statistics alone can frighten you.”

Some of Gregg’s ‘scary tale’ has already been debunked by Saturday’s very prescient New York Times editorial and, as it turns out, Gregg’s own TV appearances:

MYTH — HIGHER PREMIUMS: “President Barack Obama and congressional Democrats promised us that the new law would lower premiums. It has not. Premiums in 2011 will rise more than 12 percent for employer-sponsored coverage, according to a recent Hewitt Associates study.”

FACT: That Hewitt study actually found that the new consumer protections in the health care law are at most responsible for 1% to 2% of the 12% increase that’s due to health care inflation and adverse selection, a point Gregg conceded during an appearance on Fox Business last week.”Premiums went up by an average of 8 to 9 percent, it’s estimated that 1 to 2% of that is directly a result of the health care bill,” Gregg told Neil Cavuto.

MYTH — LOSS OF EXISTING COVERAGE: “We were promised that, if we liked our coverage, we could keep it. But we were misled. The Obama administration recently revealed that employees of nearly 70 percent of U.S. businesses, who get coverage through their job, may lose their current health care plan because of the new regulations.”

FACT: Insurers and self insured employers make policy adjustments all the time and over the last few years they’ve been slowly shifting the risks and costs of coverage to the individual. Regulations in the Affordable Care Act will discourage employers and insurers from stiffing beneficiaries with very high costs and insufficient benefits and shield consumers from drastic benefit cuts or cost shifts. If Republicans are successful in repealing these requirements, insurers and employers will be able to avoid abiding by the popular consumer protections, no matter how dramatically they cut benefits, raise co-pays, or lower employer contributions.

MYTH — MCDONALD’S DROPPING COVERAGE: “These workers may lose access to their current benefits because the government will prohibit their employers from offering a plan that is affordable and provides substantive benefits for working families.”

FACT: As the New York Times explained on Saturday, “The administration has granted some 30 waivers for one year (Rush Limbaugh promptly accused the administration of allowing these employers to “break the law”) and has signaled willingness to smooth out other bumps on the road toward full reform.” Republicans, however, are intent on criticizing the administration for addressing this problem.

MYTH — SENIORS AT RISK: “Even seniors are at risk. The Obama administration announced that nearly one million seniors will lose their current Medicare Advantage plans next year.”

FACT: CMS actually projects that 99.7% of seniors will continue to have access to a Medicare Advantage plan and that only a small number of fee-for-service plans will leave the market. This is because of a 2008 bipartisan bill that required issuers to establish provider networks, not the Affordable Care Act. The bill was vetoed by President Bush, but passed again the Senate with a two-thirds majority. Gregg did not support the legislation.

MYTH — INCREASES HEALTH COSTS: “Even the Obama administration’s own actuaries found that health care spending will increase under the new law, consuming an even larger share of our nation’s fragile economy. ”

FACT: This is not what “the Obama administration’s own actuaries found.” They concluded that beginning in 2014, as 30 million+ individuals begin receiving health care coverage and visiting doctors, health care expenditures will naturally increase. Costs will continue to grow higher than current law until around 2015, at which point the Medicare savings, the excise tax on so-called Cadillac health plans, and the Medicare payment board will cause costs to “decelerate.” Moreover, the actuaries predict that as a result of these savings, Medicare spending will decline $86.4 billion from previous projections due to reforms. “Specifically, average annual Medicare spending growth is anticipated to be 1.4 percentage points slower for 2012–19 than we projected in February 2010. By 2019, it is projected to grow 7.7 percent—0.9 percentage point more slowly than we projected in February 2010,” the report concludes.

MYTH — INCREASES THE DEBT: “The current pace of government expansion and federal spending is unaffordable and unsustainable. The national debt will double in five years and triple in 10 under the Democrats’ spending plans.”

FACT: The CBO estimates that the law will produce “$143 billion in net budgetary savings over the 2010-2019 period” and reported that repealing the law would increase the debt by that amount.

Significantly, Gregg does not call for repealing the law, as he has in months past. He merely writes, “It is my hope that the next Congress consists of members who will pass reforms that responsibly address our health care needs while improving the economy.” The language is part of an ongoing GOP campaign to temper expectations for repeal.

Fox News Sunday host Chris Wallace pressed West Virginia Governor Joe Manchin (D-WV) — who is running to fill Robert Byrd’s seat in the Senate — on his past support for the health care law yesterday, asking the governor if he regretted saying that he would have voted for the law just six months ago.

Manchin told Wallace that that he didn’t know what was in the bill when he told the National Governors Association on March 17, “I’d be for it. I think you’ve got to move the ball”:

WALLACE: You’re saying now that if you had known what was really in the bill, although last March you said you would have voted for it, you are now saying you would have voted against it?

MANCHIN: Correct. Knowing the existence as far as how reaching it had been, as far as, I would have. And I think many people didn’t know about the bill. It ends up 2,000 pages or more. Bottom line, the concept was great as far as pre-existing conditions, how do we make sure more people have affordable insurance, how do we take care of children … keeping children on insurance longer because of the market conditions. There are a lot of good parts to it. Why won’t we fix what is wrong with it and make it better.

Watch it:

Manchin, who has held many different positions on the health care law, had previously told Fox News that he would vote to repeal the entire law if it couldn’t be fixed. While some of the governor’s gripes about the 1099 provision have bipartisan support, his new found opposition to the abortion language and “the mandates” is deliberately nonspecific and haphazard.