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February 16, 2017

Here's how the Trump admin plans to change the ACA exchanges

Daily Briefing

    CMS on Wednesday unveiled a proposed rule that contains new regulations for the Affordable Care Act's 2018 coverage year.

    The proposed rule, which includes reforms for both the individual and small group health insurance markets, would shorten the ACA's open enrollment period by six weeks, give states the authority to determine whether health plans have appropriate provider networks, and provide insurers more flexibility in covered benefits.

    The proposed rule comes as congressional Republicans pursue plans to repeal and replace the Affordable Care Act (ACA) and just days after HHS Secretary Tom Price was confirmed by the Senate.

    According to CQ Roll Call, the rule's release highlights the time crunch the Trump administration faces for enacting 2018 coverage year changes. Insurers had said they needed clear direction on where the marketplace is headed by late March in order to meet the May deadline for 2018 premium proposals.

    Proposed rule details

    CMS in the proposed rule would move up the enrollment deadline for the 2018 coverage year from Jan. 31, 2018, to Dec. 15, 2017. The open enrollment period would still begin Nov. 1, 2017.

    CMS said the change would align the marketplaces with the employer-sponsored insurance market and Medicare and is intended to encourage individuals to maintain continuous coverage and not to enroll "only after they discover they require services." According to CQ Roll Call, the Obama administration planned to make a similar change in the future.

    Individuals who enroll through special open enrollment periods would be required to provide proof of eligibility before enrolling. The Obama administration last year began testing a similar policy but decided against fully implementing the change because of concerns it would pose a significant barrier to obtaining insurance, CQ Roll Call reports.

    Further, insurers under the rule would be allowed to refuse coverage to an individual who has missed premium payments within the past year until they make those payments. Current policy requires insurers to immediately begin covering individuals who sign up for exchange plans via special enrollment periods.

    CMS also proposed changing the actuarial levels—the percent of an individual's health care costs the plan would cover—that plans in each metal tier must meet. According to CQ Roll Call, this change would "make it slightly easier for insurers to offer skimpier plans." CMS said it plans to propose a revised timeline for the qualified health plan certification and rate review process for the 2018 coverage year.  

    In addition, the proposed rule would remove the Obama administration's network advocacy requirements and instead allow states to determine whether health insurance plans have adequate networks of doctors and hospitals.

    The proposal notably does not include a proposal that was rumored to be under consideration that would allow insurers to charge older enrollees 3.49 times more for premiums than younger enrollees, Axios reports. Before the rule was released to the public, some experts questioned the legality of increasing the age-band ratio under the ACA.

    CMS will accept comments on the proposal until March 7.


    Ceci Connolly, president and CEO of the Alliance of Community Health Plans, said the proposal is "a promising first step" toward strengthening the ACA market as GOP lawmakers look to repeal and replace the law. However, she said the proposals do "not address all of the uncertainty for plans and patients alike."

    Aetna Chair and CEO Mark Bertolini said the proposals represent "some good initial steps," adding, "After numerous discussions with the administration and congressional leaders, I am optimistic that they are totally committed to an ACA replacement package that will better meet consumer expectations."

    Marilyn Tavenner, president and CEO of America's Health Insurance Plans, in a statement commended the administration on the proposals. Tavenner said, "While we are reviewing the details, we support solutions that address key challenges in the individual market, promote affordability for consumers, and give states and the private sector additional flexibility to meet the needs of consumers. We appreciate the administration's efforts in proposing policies intended to address stability, affordability, and choice, helping consumers get the coverage they need."

    House Energy and Commerce Committee Chair Greg Walden (R-Ore.) and Health Subcommittee Chair Michael Burgess (R-Texas) together said the proposed changes would "help protect taxpayers and stabilize markets."

    However, Andy Slavitt, who stepped down as acting CMS administrator last month, criticized the proposed rule and the Trump administration for creating "a manufactured crisis with talk of repeal but no plan to replace, nonenforcement of the rules and reducing outreach around so fewer people would sign up for coverage." Slavitt added, "If the administration is serious about strengthening the [Obamacare] marketplace, they will reduce uncertainty and focus on keeping the marketplace stable and growing — not focus on changes that will raise deductibles, reduce access to physicians and put limitations on the ability for people to get coverage" (Nather, Axios, 2/15; Banerjee, Reuters, 2/15; Mershon, CQ Roll Call, 2/15 [subscription required]; Bryan, Business Insider, 2/15; CMS release, 2/15; Mangan, CNBC, 2/15).

    Health care industry trends for 2017


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