CMS unveils proposed rule to shore up ACA exchanges

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The Centers for Medicare & Medicaid Services revealed a proposed rule Wednesday designed to stabilize the individual insurance markets established by the Affordable Care Act.

The federal government released a proposed rule Wednesday that aims to stabilize the Affordable Care Act exchanges while Republican lawmakers and the Trump administration debate the future of the healthcare law.

The proposed rule (PDF) from the Centers for Medicare & Medicaid Services would include six key changes:

  • Individuals looking to enroll in Healthcare.gov plans during such special enrollment windows would have to submit documentation to ensure that they are eligible. This is designed to curb abuse of the system, encourage year-round enrollment and push down premiums, CMS said
  • Insurers would be allowed to collect premiums for prior unpaid coverage before enrolling a patient in the next year’s plan with the same issuer. The idea is to encourage potential enrollees to avoid coverage gaps.
  • Adjustments would be made to the de minimis range used to determine coverage levels, which could allow insurers to offer more options for coverage
  • CMS would defer to state authorities to assess issuer network accuracy and improve the quality of networks
  • CMS would revise its 2018 schedule for reviewing qualified health plans to allow insurers extra time to implement changes for the coming year
  • The rule would shorten the open enrollment period for 2018, limiting it to between Nov. 1 and Dec. 15

The Trump administration has been mulling changes to stabilize the individual markets since the beginning of the month, and the content of two draft rules leaked last week. The rule echoes similar proposals introduced in the House of Representatives, designed to replace elements of the ACA piecemeal as it is repealed. President Donald Trump has called for a quick repeal of the law, but what comes next is less clear, as he said a replacement plan may not be ready until next year.

Patrick Conway, M.D., acting head of CMS, said in an announcement that the newly proposed rule will help protect people enrolled in individual marketplace plans as ACA reforms continue to shape up. “Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” Conway said.

Ceci Connolly, president and CEO of the Alliance of Community Health Plans, said in a statement that the rule addresses the concerns of a variety of stakeholders in the individual market and that it is a “promising first step,” though there’s more work to be done.

“The new rule begins to address concerns about the stability of the individual market, but does not resolve all of the uncertainty for plans and patients alike,” Connolly said. “Without adequate funding it will be extremely difficult to provide high-quality, affordable coverage and care to millions of Americans.”