NASHVILLE, Tenn.—While he’s far from certain what will happen to the Affordable Care Act on the legislative front, one federal health official says the new Trump administration has already taken an important step to minimize disruption in the individual markets.
That step comes in the form of the recently proposed federal rule aimed at improving the risk pool in the marketplaces and giving states, insurers and patients more flexibility, Jeffrey Grant, the director of payment policy and financial management for the Center for Consumer Information and Insurance Oversight (CCIIO), told attendees at the 2017 RISE Summit.
“The message of this administration is, let’s stabilize this thing,” he said.
Many of the rule’s provisions, he noted, were drafted in response to insurers’ concerns, such as tightening regulations around special enrollment periods and letting issuers collect premiums for prior unpaid coverage before enrolling a patient in a plan for the next year.
The proposed rule’s shortening of open enrollment periods, meanwhile, is likely to help health plans simply because it might give them one more month of having healthier members in the risk pool, as such individuals often wait until the last minute to sign up for plans.
Another provision—widening the actuarial “de minimis range” used to determine coverage levels—essentially allows insurers to offer plans with skimpier coverage, Grant said. While he pointed out that this shifts more costs onto sicker patients, he argued such a move may be necessary to keep insurers in the market.
“If you’re not making a profit, you get out of this industry, and we see that continue to happen, so we need to help the issuers out," he said.
Pushing for improvement in risk adjustment
For Grant’s group at CCIIO, he said he’s whittled down its diverse responsibilities to focus on a simple motto: “Pay right, pay on time, every time.”
The goal of paying on time, for example, can translate to federal regulators striving to collect payments promptly rather than having to charge interest or ultimately refer unpaid debts to the Treasury. “This year, we have a goal that we will refer no debt to Treasury,” he said.
As for "paying right," the agency’s payment policy and financial management group strives to ensure that risk adjustment transfers represent the most accurate reflection of the relative risk each issuer has assumed in the market, Grant said.
Achieving that goal means pushing for earlier EDGE server data submissions. “We nag a lot of you guys” about that, Grant said, speaking to the health plan leaders in the room. But there’s good reason for that, he added, as having incomplete data results in unfairly advantaging some issuers while unfairly disadvantaging others.
Insurers can help improve the accuracy of risk adjustment transfers, he said, if they improve their data management, with a focus on correcting errors; build in checks and audits to ensure data quality; and forecast their results and compare that to EDGE forecasts.
"We are partners in making this program work," Grant said.