While they generally support more regulatory flexibility for insurance markets, payers, underwriters and actuaries want the federal government to be careful about how much power it hands over to the states.
The organizations voiced some of their concerns in recently filed comment letters about the 2019 Notice of Benefit and Payment Parameters—an annual omnibus rule that outlines regulations for the individual and small-group markets under the Affordable Care Act.
One major theme that emerged was the fact that insurers aren’t sold on the prospect of giving states more power to define their essential health benefits (EHB) benchmark plans. The Blue Cross Blue Shield Association, for example, wrote that the proposed rule “would allow states to increase the benefits offered under their EHB package without being held responsible for any resulting cost increases.”
“We are concerned that this policy could cause costs to increase in the individual market unless the proposal is modified to require states to defray the cost of additional benefits added,” the trade group added.
Here’s a look at what other insurers and organizations had to say:
- Centene wanted HHS to postpone any changes to the EHB benchmark plan selection until 2020, arguing that the proposed timeline, which would allow states to make changes as late as March 16, 2018, would “greatly disrupt” insurers’ ability to plan for 2019.
- Anthem said that letting states change their EHB benchmark plan annually and select from additional benchmark plan options could result in “less affordable coverage and consumer confusion.” Enrollees have come to expect a degree of consistency among plan benefit packages from year to year, Anthem noted.
- Aetna said it supported the proposal to offer more flexibility for EHB benchmark plans, but echoed Centene in calling for more lead time for EHB changes for the 2019 plan year. It also suggested limiting states to changing to their benchmarks less frequently than every year.
- Cigna expressed a similar position, specifically suggesting that states not be allowed to change their EHB benchmark plan any more often than every three years.
- Kaiser Permanente pointed out that letting insurers substitute among EHB categories could lead some to devalue certain categories like maternity and behavioral health services. “These changes would incentivize issuer gaming based on risk selection and reduce access to services needed by many of our most vulnerable populations,” it said.
- Molina Healthcare noted that allowing states to select a set of benefits for its EHB benchmark plan would open up EHB categories “to be influenced by special interest groups and state regulators, rather than what is medically necessary.”
- The National Association of Health Underwriters said it supports the concept of giving the states greater authority relative to EHB subcategories and plan-design approval, but warned that “excessive flexibility can lead to market chaos.” The group also noted that a regulatory change of that magnitude “will require a substantial investment of resources at both the state and issuer levels” to pull off.
- The American Academy of Actuaries wanted the Department of Health and Human Services to be more specific about how the new EHB regulations would work. For example, it said that the rule is too vague about the requirements to “maintain an appropriate balance between EHB categories and to provide benefits for diverse segments of the population.”
Beyond their concerns about the EHB changes, however, many of the payer organizations supported the government’s proposal to nix the standardized plan options from the ACA exchanges. As Centene put it: “Our experience has shown these plans have low enrollment and are more expensive than other plans within markets, and may discourage consumers from fully exploring all available options to find a plan that best fits their individual needs.”