Trump administration drafts rule aimed at stabilizing ACA exchanges

The Department of Health and Human Services sent a proposed rule to the Office of Management and Budget this week titled “Patient Protection and Affordable Care Act; Market Stabilization."

Amid increasing warnings that insurers could drop out of the individual marketplaces next year, the Trump administration has drafted a new rule that aims to stabilize the exchanges.

The text of the rule, which the Department of Health and Human Services sent to the Office of Management and Budget this week, has not yet been published. But its title, “Patient Protection and Affordable Care Act; Market Stabilization,” suggests that it will contain provisions to shore up the exchanges, which were on shaky ground even before Republicans began the process of repealing the health law that created them.

During their quarterly earnings calls this week, the top executives of Aetna, Anthem and Cigna all offered an evaluation of their ACA exchange experience, with some outlining suggested policy fixes to make the market more viable. 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.

During a Senate hearing on Wednesday, expert witnesses from 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, pointing out that carriers must decide in the spring what plans to offer and how to price them.

In addition to HHS’ proposed regulation, the House held a hearing on Thursday to debate four separate bills that seek to prop up the marketplaces. They would do so by altering ACA provisions like the grace period for receiving premium tax credits, eligibility for special enrollment periods and the rate-banding rule—all of which are the specific fixes suggested by insurance industry leaders.

This approach signals a subtle change in GOP strategy from simply repealing and replacing the ACA to repairing it in the interim, as FierceHealthcare has reported.

Yet in his weekly press briefing, House Speaker Paul Ryan argued that “repair” and “repeal and replace” don’t have to be mutually exclusive.

“Our job is to repair the American healthcare system and rescue it from the collapse that it’s in,” he said. “The best way to repair our healthcare system is to repeal and replace Obamacare. It’s not an either-or.”

Watch Ryan's full press briefing: