Trump admin releases final ACA 'market stabilization' rule

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The Department of Health and Human Services has finalized several tweaks to ACA exchange regulations.

The Trump administration released a final rule on Thursday aimed at stabilizing the Affordable Care Act marketplaces.

The final version of the rule is largely unchanged from the proposed rule, which the administration released in February.

In a statement announcing the final rule, Centers for Medicare & Medicaid Services Administrator Seema Verma emphasized that the tweaked regulations are not an endorsement of the ACA.

“While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system,” she said.

The rule will shorten the 2018 open enrollment period, having it begin Nov. 1, 2017, and end Dec. 15, rather than ending Jan. 31, 2018. That change, the rule says, “will encourage healthier individuals who might have previously enrolled in partial year coverage after December 15th to instead enroll in coverage for the full year.”

The rule also makes changes to special enrollment period rules to discourage “potential misuse,” such as requiring pre-enrollment verification of 100% rather than 50% of new consumers who seek to enroll using an SEP for all the states served by Healthcare.gov.

In another bid to promote continuous coverage, the rule will let insurers require individuals to pay back past-due premiums before enrolling in a plan with the same insurer the following year. 

Insurers will also get more benefit design flexibility, reflected in an increase in the de minimis variation in the actuarial values used to determine metal levels of coverage starting in 2018.

Further, the rule finalizes an approach to network adequacy that includes deferring to states with sufficient review processes and loosening the rules surrounding essential community providers.

The final rule acknowledged that some of the more than 4,000 comments that the Department of Health and Human Services received were critical of the proposed regulation changes, suggesting that it would benefit insurance companies while harming consumers’ access to affordable health coverage and weaken consumer protections under the ACA.

In response, HHS noted that the final rule does not change the majority of standards for qualified health plans, adding that it believes the administrative action is necessary to stabilize the exchanges.

For its part, major trade group America's Health Insurance Plans appreciates changes in the final rule such as tightening up rules for special enrollment periods, greater flexibility in product and benefit design and simplified administrative processes, spokeswoman Kristine Grow wrote in an emailed statement.

“However, there is still too much instability and uncertainty in this market," she wrote. "Most urgently, health plans and the consumers they serve need to know that funding for cost-sharing reduction subsidies will continue uninterrupted." 

AHIP and other leading healthcare industry trade groups sent a letter to President Donald Trump this week urging him to continue funding those subsidies, warning that failing to do so would upend the individual markets.

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