In the wake of the Obama administration’s proposed rule to amend the exchange marketplaces, healthcare industry experts aren't sure whether the changes go far enough to fix the Affordable Care Act.
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Some of the fixes--like factoring in prescription drug use for determining risk profiles for possible enrollees and shoring up rules for the Special Enrollment Period--are common sense, Michael Abrams, a global healthcare consultant with Numerof and Associates, told FierceHealthPayer during an exclusive interview.
But he's skeptical over some of the other proposed changes. “Some are just counter-intuitive, like the proposal to spread excess losses from high-cost patients experienced by one insurer across other insurers,” Abrams said.
Nate Hunt, director of Cleveland-based University Hospitals Accountable Care Organization, told FierceHealthPayer that CMS intends to make the exchanges more attractive for insurers but it remains to be seen how the models turn out.
However, he was positive about one of the proposals to use new technology to provide users with a transparent way to enroll on marketplace plans. “Anytime you can engage folks and get them more involved with treatment options, it is worth it to try,” Hunt says.