Insurers have been pressuring the Trump Administration to relieve some of the uncertainty from the pending ACA “repeal/replace” debate in time for them to decide whether to participate in the individual health insurance Exchange markets next year. On Feb. 15, federal regulators issued proposed measures intended to stabilize marketplaces while lawmakers are still deciding the long-term future of the ACA. The rules changes, if adopted, will shorten the open enrollment period, decrease benefits, and give states more oversight. The proposed changes also address concerns from insurers that too many consumers are ignoring the individual mandate, unlawfully using special enrollment periods when they become sick, and dropping coverage shortly afterwards.
Here are key provisions in the proposed rule:
- For plan years starting Jan. 1, 2018, and onward, there would be a shorter open enrollment period, running from Nov. 1 to Dec. 15, instead of Nov. 1 to Jan. 31. Regulators assert that this six-week period would align better with many open enrollment periods for employer-based coverage, as well as with the open enrollment period for Medicare. This accelerates a change originally scheduled to take place in 2019.
- Consumers seeking to use any of the categories of special enrollment periods (for example, loss of employer-provided coverage or a qualifying event such as marriage) would be required to verify their eligibility with HHS at the time of enrollment. This change was a top priority for insurers to protect against abuses and adverse selection, but is only mandatory for federally run Exchanges.
- Insurers would be authorized to collect unpaid premiums from consumers whose policies were terminated due to failure to pay premiums before having to reenroll them in the coming year’s plan.
- Marketplace insurers would have more flexibility to provide fewer benefits than currently prescribed by law, up to a margin of 4%.
- Federal regulators would defer to states to assess whether ACA policies have adequate provider networks.
The proposed rule did not include a rumored change to allow insurers to charge higher premiums for older enrollees. Even if the proposed changes are adopted—and they seem to be on a fast track to be finalized in March—it remains to be seen whether insurers will remain in a market whose existence beyond 2017 is still uncertain.