What the Trump administration's ACA exchange fixes could include

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The Trump administration is considering changes to the Affordable Care Act designed to keep payers in the law’s healthcare marketplaces.

More details have emerged about the regulatory changes President Donald Trump’s administration is planning to make to the Affordable Care Act exchanges in a bid to keep insurers participating in those markets while Republicans formulate the law's replacement.

The Department of Health and Human Services sent the draft of a regulation to the Office of Management and Budget last week called “Patient Protection and Affordable Care Act; Market Stabilization,” but the text of the rule was not yet available.

But two similar draft documents recently obtained by Politico offered a peek at what the final regulation might include. They showed that the Trump administration may seek to:

  • Loosen the rate-banding rule from a 3:1 ratio to a 3.49:1 ratio, allowing insurers to charge older enrollees higher premiums
  • Reduce the length of the 2018 enrollment period, only allowing consumers to sign up for plans between Nov. 1 and Dec. 15
  • Require all individuals who sign up for plans outside the standard enrollment window to provide documentation proving they’re eligible before their coverage takes effect
  • Tighten the 90-day-grace period for enrollees who stop paying premiums
  • Offer insurers more flexibility in how much of consumers' out-of-pocket medical expenses they have to cover

The changes echo a series of bills drafted in the House of Representatives that are designed to replace some parts of the healthcare law should a repeal go through during budget reconciliation as planned. But some Democrats oppose this strategy, with one lawmaker calling the four bills “half-baked” at a House hearing last week.

It’s also a signal that the Trump administration is slowing down its timetable for the repeal and replace effort, and comes on the heels of the president saying a replacement plan may not be ready until next year


Last week, expert witnesses from organizations including America’s Health Insurance Plans, the National Association of Insurance Commissioners and the National Association of Health Underwriters all urged Congress to take action to stabilize the marketplaces by March, before insurers are required to decide about their participation for 2018. And on recent conference calls with investors, the CEOs of Anthem and Cigna indicated they are still evaluating whether to participate in 2018, while Aetna’s Mark Bertolini said the insurer will not re-enter any marketplaces that it left in 2017.

The two drafts don’t contain, however, language that suggests Trump’s administration would make changes to the ACA’s individual mandate, Politico pointed out, which his surrogates have previously suggested he may no longer enforce.