States with less regulation of short-term limited duration health plans had higher rates of late-stage cancer diagnosis

April 2, 2025

Summary: States that allowed STLD plans from 2018-2020 had higher rates of late-stage cancer diagnosed in subsequent years

Source: Yang, et al JAMA Network Open March 18, 2025 . * The differences between groups 3 and 4 were statistically significantly different than group 1. In this graphic, 1.84 is an 84% higher rate of late-stage cancer diagnosis.

The first Trump Administration eased regulations on short-term limited duration health (STLD) plans, which are far less expensive than health plans that meet all of the requirements of the Affordable Care Act. These plans, which were initially designed for people who would be out of a job for a short time, often don’t cover essential health benefits such as maternity care, pharmacy, or mental health. They also often have low caps on the total amount they pay out, so they can leave members who have serious illnesses with unexpected out-of-pocket costs. STLD plans also generally require substantial cost sharing on cancer screening.

The Biden Administration limited these plans to just three months, and some states prohibited or regulated them during the first Trump Administration. Executive Order 14148 rescinded the executive order that led to the restrictions on STLDs, although rescinding the regulations will take more time. Some employers will likely be presented with the potential to lower their premiums by moving to this type of health plan.

Research published in JAMA Network Open this month used the natural experiment of some states regulating or prohibiting these plans to assess whether these STLD plans are associated with a higher rate of diagnosis of later-stage cancer. They compared late-stage cancer rates in states that had no STLD plans from 2018-2020 (groups 1-2 on the chart above) with late-stage cancer diagnosis in states that had regulated such plans only a little (group 3) or not at all (group 4). They evaluated the stage of cancer diagnosis from the National Cancer Database.

This is an observational study with relatively short follow up and does not prove that these plans are associated with a later stage of cancer diagnosis. The researchers extensively adjusted this data to account for sociodemographic issues (including poverty, gender, and age).

Implications for employers:

● Employers should be cautious about low-cost limited benefit plans that are not compliant with the Affordable Care Act.

○ If these are offered as a full replacement, those with serious illnesses will likely have high out-of-pocket costs.

○ If these are offered alongside traditional health plans, they will likely attract healthier plan members, leading to higher costs in the traditional plan.

Tomorrow: Inflation pharmacy rebates could save employers billions

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