ACS CAN comments on Short-term Limited-Duration proposed rule

September 9, 2023

The American Cancer Society Cancer Action Network (ACS CAN) appreciates the opportunity to comment on short-term, limited-duration (STLD) insurance proposed rule offered by the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Internal Revenue Service (IRS) (collectively “the Departments”). ACS CAN is making cancer a top priority for public officials and candidates at the federal, state, and local levels. ACS CAN empowers advocates across the country to make their voices heard and influence evidence-based public policy change, as well as legislative and regulatory solutions that will reduce the cancer burden. As the American Cancer Society’s nonprofit, nonpartisan advocacy affiliate, ACS CAN is more determined than ever to end cancer as we know it, for everyone.

ACS CAN supports the regulations proposed by the Departments. We have long been concerned about the availability of short-term plans[1] that traditionally have low premiums but fail to provide the kind of comprehensive coverage an individual would need if they were diagnosed with a serious and unplanned disease such as cancer. Issuers offering short-term plans are permitted to engage in medical underwriting - denying coverage to people with pre-existing conditions like cancer, charging more based on a person’s health status, or refusing to cover services related to an individual’s pre-existing conditions. They are also permitted to impose lifetime and annual limits on coverage and are not required to provide coverage for the Affordable Care Act’s (ACA’s) essential health benefits. For example, many of these plans do not cover any prescription drugs, or preventive services – benefit categories that are crucial to preventing cancer, detecting it at earlier stages, and treating it. These plans are a throwback to a time when many people with serious conditions like cancer could not get or keep health insurance.

STLD policies can leave individuals with diseases like cancer financially vulnerable. For example, an ACS CAN report estimated that an individual who was diagnosed with non-Hodgkin’s Lymphoma in 2020 while enrolled in a 12-month STLD policy could face more than $51,000 in out-of-pocket costs, which was more than 4 times what other cancer patients with comprehensive insurance coverage would have paid.[1]

Additional research has shown that in states with a proliferation of STLD plans there was a decreased rate of early-stage cancer diagnoses meaning that more cancers were found at a later stage when the disease is often harder and more expensive to treat.[2] Conversely, in states that have enacted legislation prohibiting or severely limiting access to STLD plans there was an increased rate of early-stage cancer diagnosis, when more treatment options may exist and when cancer is often less expensive to treat. Unfortunately, since the 2018 rule was promulgated, the availability of STLD plans has increased significantly. It is well documented that STLD plans are often marketed and sold to consumers in a manner that is confusing and misleading.[3],[4],[5]

Finally, since the 2018 rule was promulgated,[6] the health care landscape has changed significantly such that a reinterpretation of the existing rules is warranted. Those seeking individual coverage have more affordable options for comprehensive coverage. Since 2019, issuer participation in ACA marketplace plans has increased,[7] providing consumers with more plans from which to choose. Since 2020, the generosity of the tax credits and subsidies for marketplace plans has increased, resulting in more consumers enrolling in Marketplace coverage that is more affordable, and in some cases, even free.[8] Most recently the Administration promulgated new regulations that would fix the so-called “family glitch” resulting in an estimated 1 million more individuals having access to subsidies in the Marketplace.[9]


[1] American Cancer Society Cancer Action Network. Short-term limited duration health plans leave cancer patients vulnerable to extremely high out-of-pocket costs. June 2022. Available at

[2] Barnes JM, Kirchhoff AC, Yabroff KR, Chino F.  Association of state policies regulating short-term limited-duration insurance plans and cancer stage at diagnosis. Journal of Clinical Oncology 2023 41:16_suppl, 1589-1589.

[3] Linke Young, C., & Hannick, K. Fixed indemnity health coverage is a problematic form of “junk insurance.” Brookings. October 2020. Government Accountability Office. Private Health Coverage: Results of Convert Testing for Selected Offerings. August 2020.

[4] R. Schwab and J. Volk, The Perfect Storm: Misleading Marketing of Limited Benefit Products Continues as Millions Losing Medicaid Search for New Coverage, Georgetown University Center on Health Insurance Reforms, August 2023.

[5] D. Palanker and J. Volk, Misleading Marketing of Non-ACA Health Plans Continued During COVID-19 Special Enrollment Period, Georgetown University Center on Health Insurance Reforms, October 2021.

[6] Department of Health and Human Services, Department of the Treasury, and Department of Labor. Short-Term, Limited-Duration Insurance. Final Rule. 83 Fed. Reg. 38212 (Aug. 3, 2018) [hereinafter “2018 rule”].

[7] Hempstead K. Marketplace pulse: Participation in 2022. Robert Woods Johnson Found. Jan 18, 2022. Available at

[8] Count Estimates of Zero- and Low-Premium Plan Availability, States Pre and Post ARP. April 2021.

[9] Keith K. Family glitch fix provides new affordable coverage option. The Commonwealth Fund. Nov. 3, 2022. Available at


[1] American Cancer Society Cancer Action Network. Inadequate coverage: An ACS CAN examination of short-term health plans. May 2019. Available at