On April 18, 2017, HHS released a rule entitled the Patient Protection and Affordable Care Act: Market Stabilization. The rule has five major areas that the Trump Administration believes will encourage insurers to continue to sell insurance plans through the market:
- Shortening the Open Enrollment Period: The open enrollment period for insurance plans starting on January 1, 2018, was November 1, 2017 through January 31, 2018. The rule changes the open enrollment period to November 1, 2017 through December 15, 2017. HHS says this new open enrollment period will serve as an incentive for people to enroll rather than choosing to enroll later if they “learn they will need medical services in late December and January.” HHS believes this will change will influence an individual’s decision to stay enrolled and decrease the incentives for individuals enrolling only after they need health care services.
- Increasing Pre-Enrollment Verification: Currently, when an individual needs to enroll in a health plan outside the open enrollment period, it is referred to as a special enrollment period (SEP). Events that would trigger an SEP including moving from another state, losing a job, having a baby, getting married or divorced, etc. Insurers are concerned that people were using SEPs as a way to get enrolled in a health plan when they were sick and needed services, and not because they actually qualified for an SEP. In response, the Trump Administration will now require documentation to verify that an individual qualifies for the SEP. Births will be verified through existing electronic verification methods. For other circumstances, individuals will have 30 days from picking a Qualified Health Plan (QHP) to provide verification documentation to the state.
- Changing Interpretation of Guaranteed Availability Regarding Unpaid Premiums: The Trump Administration’s rule would allow insurers, subject to state law, to apply a health care premium payments to past debts acquired by not paying previous insurance premiums. The individual’s past debt owed could be from the same insurer or a different—but connected—insurer within a 12-month period. Prior to the change, insurers could only apply a premium payments to an individual’s new insurance. HHS believes this provision will encourage individuals to stay ensured and have “continuous coverage.” Opponents of the rule say that many people believe that can leave their plans simply by not paying, and many consumers do not know that they actually have to alert the insurer to terminate their policies. Additionally, they are concerned that lower-income individuals will not be able to pay both the debt owed and the new payments, which will result in people being uninsured.
- Lower the Actual Value of the Metal Levels of Insurance: Actuarial value is the average amount that health insurers expect to pay out in claims or, in other words, the percentage of expected health care costs for a specific population. The metal levels are how health insurance plans are organized on the Exchange, and they include Bronze, Silver, Gold, and Platinum. The rule allows insurers to reduce the actuarial value by 2 percent, which means that insurers can cover, on average, 2 percent less than they cover now. The 2 percent reduction would allow insurers more flexibility to design plans, and it would not apply to cost-sharing such as out-of-pocket limits or coinsurance, but it would apply to deductibles. (Coinsurance is a percentage of the costs that individuals must pay. For example, if a patient has a 20 percent coinsurance and the bill was $100, the patient is responsible for $20. A deductible is the amount that a patient must pay prior to the health insurance plan covering most services.) It is expected that the rule will result in deductibles increasing 2 percent.
- Increasing States’ Role: The rule aims to reduce the regulatory burden on insurers by deferring some federal requirements to the states. One requirement is network adequacy, which required insurers to have a minimum number of doctors and specialists to whom patients could be referred. Requirements for these providers will be reviewed at the state level.