The Trump administration's first move on Obamacare would shorten health plan enrollment periods and beef up pre-enrollment eligibility verification.
The White House may be moving too slowly for some supporters on its promise to repeal and replace Obamacare, but under pressure from payers, it is taking interim steps to calm an increasingly unstable healthcare insurance market.
With large players such as UnitedHealthcare and Humana pulling out or vowing to exit the marketplace, the Trump administration's first alteration of the Affordable Care Act is meant to shore up the failing market until more significant changes are made.
The Centers for Medicare & Medicaid Services issued a proposed rule for 2018 that would make changes to
- Special enrollment periods
- The annual open enrollment period
- Guaranteed availability
- Network adequacy rules
- Essential community providers
- Actuarial value requirements
The proposal also announces upcoming changes to the qualified health plan certification timeline. CMS calls the proposed changes "critical to stabilizing the individual and small group health insurance markets to help protect patients."
The move comes a day after Humana, one of the nation's largest health insurers, announced that it will stop selling Obamacare health plans next year, citing mounting losses caused by overutilization.
Other major health plans left the market in 2016 for the same reason. Though Humana did not have a major share of the ACA market, the pullout of such a big name nonetheless was seen as one more nail in the coffin for the controversial law.
Anthem, the nation's second largest insurer coverage in 14 states, also has one foot out the door. CEO Joseph Swedish the company is waiting to see what short-term fixes the Trump administration will make to the exchanges before deciding whether to participate next year.
CMS Acting Administrator Patrick Conway, MD, said the proposed rule is intended to ensure that consumers in the individual health insurance markets will have as many health insurance options as possible.
"This proposal will take steps to stabilize the marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options," Conway said. "They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated."
Consumers Would Have Less Time
The proposed rule offers relief to beleaguered insurers in several ways, first by shortening the upcoming annual open enrollment period for the individual market.
For the 2018 coverage year, the enrollment period would be November 1, 2017, to December 15, 2017, which CMS says would "align the marketplaces with the employer-sponsored insurance market and Medicare, and help lower prices for Americans by reducing adverse selection."
In addition, the rule would expand pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods in marketplaces using the HealthCare.gov platform. This proposed change would ensure that special enrollment periods are available to all who are eligible, but would require individuals to submit supporting documentation, a common practice in the employer health insurance market.
This change would help place downward pressure on premiums, curb abuses, and encourage year-round enrollment, CMS says.
To discourage coverage lapses, the rule would allow an issuer to collect premiums for prior unpaid coverage, before enrolling a patient in the next year's plan with the same issuer.
It also would make adjustments to the de minimis range used for determining the level of coverage by providing greater flexibility to issuers to provide patients with more coverage options.
In a move that gives more control back to the states, the proposed rule requires CMS to defer to the states' reviews in states with the authority and means to assess issuer network adequacy.
CMS also announced in the rule its intention to release a revised proposed timeline for the qualified health plan certification and rate review process for plan year 2018 that CMS says will give insurers more flexibility to incorporate benefit changes and maximize the number of coverage options available to patients.
Gregory A. Freeman is a contributing writer for HealthLeaders.