Special enrollment period policies that favored increasing enrollment over maintaining coverage are one of the main culprits behind expected double-digit premium increases in 2017, according to a Forbes contributed post.
Scott Gottlieb, M.D., a resident fellow with the right-leaning American Enterprise Institute, argues that a litany of SEP policies undermined the Affordable Care Act's open enrollment periods, allowing beneficiaries to cycle in an out of plans when they became ill and required insurance.
SEPs also were attractive options to higher-cost individuals who were more likely to allow their coverage to lapse, according to Gottleib, echoing complaints from health insurers that SEPs are vulnerable to abuse.
Various loopholes have exacerbated the already broad SEP policies, Gottlieb argues, which added too many sicker, costlier consumers to the risk pool. Now, ACA exchange consumers are paying the price with large premium increases expected in several states
Earlier this month, the Centers for Medicare & Medicaid Services released an interim final rule that would tighten SEP eligibility requirements. But Gottleib says to truly fix the problem, the Obama administration must to adopt a "new political ethic" that better balances health insurance access and affordability concerns.
One expert, however, has argued that too few consumers take advantage of SEPs, and tightening the eligibility rules could actually hurt insurers by deterring healthy people from enrolling in ACA plans when they experience a qualifying life event.
To learn more:
- read the Forbes post
Insurers predict hefty premium hikes in 2017
The downside of tightening special enrollment period rules
CMS tweaks CO-OP, special enrollment period regulations
CMS outlines changes to special enrollment period rules
CMS reveals new verification process for special enrollment eligibility
Special enrollment periods costly and open to abuse, insurers warn
Government won't offer a special tax season enrollment period this year