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Insurance Plans Accept Mandate on its Way Out

News  |  By Gregory A. Freeman  
   December 14, 2016

AHIP, the health plan lobbying group, acknowledges the Trump administration probably will eliminate the individual mandate and offers to work on a plan to avoid lapses in coverage.

It is apparent even before president elect Donald Trump takes office that the Patient Protection and Affordable Care Act will undergo significant changes and the often criticized individual mandate is likely to be one of the first targets.

AHIP, the insurance industry's lobbying organization is acknowledging that fact and urging the Trump administration to work with it on a plan that will ensure the individual market is not rattled by people suddenly dropping their coverage.

Rep. Tom Price, (R-GA), Trump's pick for health and human services secretary, has promoted a plan for years that would modify or replace the Affordable Care Act.

It includes eliminating the individual mandate. His Empowering Patients First Act would ban coverage denial and higher premiums for people with pre-existing conditions, but only if they had continuous insurance coverage during the previous 18 months.

With that individual mandate repeal looking more and more likely, America's Health Insurance Plans is suggesting Congress can avoid disruption in the individual market by financing cost-sharing reduction payments and the ACA's temporary reinsurance program through 2019, addressing special enrollment periods, adjusting the certification process time frame and reducing regulatory burdens.

"The Affordable Care Act will see significant changes," AHIP says.

"Those changes can either begin a stable transition to a better approach, or they can bring about even more uncertainty and instability. Everyone wants an individual market that works. That's why we should all work together to find solutions that deliver both short-term stability and long-term improvement."

AHIP stresses that the foundation of an effective individual insurance market is continuous coverage for everyone, both those who utilize their coverage and those who are healthy but still have insurance. Finding effective incentives for continuous coverage is essential to avoid even higher premiums and fewer choices for consumers, it says.

The group says lawmakers should follow key principles as they begin the process of improving the individual market: A strong commitment to continuous coverage; delivery of affordable coverage, including tax credits and potentially high-risk pools; protecting taxpayers by boosting consumer choice and cost controls; and providing more flexibility to states.

"Millions of Americans are selecting and purchasing individual health plans now, and will continue to do so through January 2017," AHIP says. "Millions more have enrolled in Medicaid. Making sudden, significant changes now or mid-year will jeopardize the coverage they depend on."

AHIP urges Congress to replace the individual mandate with "strong, effective incentives," such as late enrollment penalties and waiting periods, that can help expand coverage and lower costs.

To help mitigate premiums, AHIP urges Congress to make the reinsurance payments for the 2016 plan year and eliminate both the health insurance tax and the Patient-Centered Outcomes Research Institute Fee (PCORCI) fee.

The insurance industry also wants the administration to implement a pre-enrollment verification system for the special enrollment periods, and to stop people eligible for Medicare or Medicaid from being steered into commercial plans.

Gregory A. Freeman is a contributing writer for HealthLeaders.

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