AHIP: How to keep individual markets stable in Trump era

Donald Trump and foreign ties
When Donald Trump and Republicans in Congress repeal the Affordable Care Act, there are several points they should keep in mind to avoid major disruption to consumers and insurers, according to America's Health Insurance Plans.

With Republicans making it clear that repealing the Affordable Care Act will be a top priority, America’s Health Insurance Plans is stressing that the coming policy changes must ensure a stable, competitive individual marketplace or risk “even more uncertainty and instability” for insurers and consumers.

“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,” the trade group said in an email to FierceHealthPayer outlining some of the ideas it has been discussing with policymakers.

One of AHIP’s major requests is to extend the timeline for health plans to file their exchange products for the 2018 marketplace. Currently the deadline is May 2017, but stretching it to the summer could give plans more certainty when submitting their bids—thus ensuring consumers continue to have a pathway to coverage, the group says.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

AHIP also calls on policymakers to continue to fund temporary and transitional programs like cost-sharing reductions and reinsurance through at least Jan. 1, 2019. CSRs, which reimburse insurers for providing consumers with subsidies, are particularly in jeopardy because the fate of a lawsuit challenging their legality will now be decided by Donald Trump’s administration.

“If insurance companies believe cost-sharing subsidies will not continue, they are going to pull out of the market during the next logical opportunity,” AHIP President and CEO Marilyn Tavenner told the New York Times.

Other AHIP suggestions for the next two years include:

  • Make reinsurance payments for 2016 as originally intended.
  • Implement effective controls on special enrollment period sign-ups.
  • Avoid coverage disruptions for people signing up for individual plans and Medicaid during the current open enrollment period.
  • Replace the individual mandate with incentives such as late enrollment penalties and waiting periods.
  • Maintain sufficient funding in Medicaid to avoid harming state budgets and jeopardizing enrollees’ coverage.
  • Eliminate the health insurance tax and the Patient-Centered Outcomes Research Institute tax.
  • Protect people who are eligible for public programs from being “inappropriately steered” into the commercial insurance market.
  • Consider “actuarially sound” methods for funding high-risk pools or other risk-mitigation arrangements.
  • Loosen regulations on network adequacy, quality reporting, rate review and other areas.

For 2019 and beyond, AHIP cautions that as policymakers look to reshape the individual markets, they should keep in mind that health plans need at least 18 months to create and file products with state regulators. They should also build enough time into any market transition to educate consumers, consider whether new state and federal rules are needed, and avoid midyear regulation changes, AHIP says.

Suggested Articles

Consumers could have saved billions in 2017 if price variation for certain services was addressed, according to a new report. 

Officials announced on Friday a proposal to remove healthcare protections for transgender patients and women seeking to terminate pregnancies.

Proposed federal rules don't go far enough to give patients and providers control when it comes to exchanging and accessing health data, AMIA says.