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The Centers for Medicare and Medicaid Services rolled out its final rule for the 2018 healthcare exchanges on Thursday.
The final rule, an update of changes proposed February 15, included a variety of changes to the indiviudal health insurance marketplaces, including cutting down on the amount of time people have to enroll for plans on the exchanges and allowing insurers to collect unpaid premiums before allowing a patient to sign up the next year.
“This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options,” the CMS’ administrator, Seema Verma, said in a statement. “They will help protect Americans enrolled in the individual and small-group health insurance markets while future reforms are being debated.”
Democrats quickly blasted the changes.
Rep. Frank Pallone, of New Jersey, the ranking Democrat on the House Energy and Commerce Committee, said the new rule “will not produce any meaningful improvements for the stability of the ACA Marketplace” and said aspects of the rule would prove negative.
“It’s time for the threats and the sabotage to end, and for President Trump to undo the damage he’s done to the Marketplaces,” Pallone said in a statement. “It’s time to work to improve the law.”
Here’s a quick rundown of the changes in the CMS rule. It would:
Limit the 2018 open-enrollment period to six weeks, half the previous length: Notably, the rule said CMS and the Department of Health and Human Services will continue to spend money on outreach to encourage people to sign up. But the shorter enrollment period – November 1 to December 15 – will most likely result in lower enrollment. Allow insurers to collect unpaid premiums before customers sign up with the same insurer the next year: The CMS release says the rule “will incentivize patients to avoid coverage lapses.” It could also discourage those who have a lapse in coverage from signing up the next year, but it could help insurers recoup some of the money lost on the exchanges. Force people to provide further identification to sign up outside the open-enrollment period: To limit the number of people who drop coverage and enroll only when they need it, the CMS rule will force people to give more identification to sign up for the exchanges outside open enrollment. This suggestion was also floated by the Obama administration. Allow insurers to determine the level of their coverage: The actuarial value of a plan is the percent of medical costs a plan would cover. The rule will allow insurers to adjust their actuarial value while still qualifying for the exchanges. In the worst case, that could mean consumers will end up with plans that cost close to the plans offered on the exchanges currently but cover fewer procedures.
Even with the changes, it is unclear whether the Trump administration will fund cost-sharing reduction payments, which most policy analysts say is key to keeping the market from collapsing.