Proposed Rule Shortens ACA Open Enrollment Period

As Republicans debate how to move forward with repealing and replacing or reforming the Affordable Care Act (ACA), the Trump administration is proposing a rule that would help stabilize the market in 2018. The released rule comes on the heels of news that Humana will exit all of the ACA exchanges beginning January 1, 2018.

According to Patrick Conway, MD, acting administrator of CMS, the proposed rule will protect people enrolled in both the individual and small group health insurance markets and help to stabilize the market.

“Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” Conway said in a statement. “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 rule would tighten enrollment in ACA exchange plans. Instead of a 3-month open enrollment period, the rule would shorten the upcoming open enrollment period for the ACA’s individual market to half that time: November 1, 2017, to December 15, 2017. The new timeline aligns the marketplace with the employer-sponsored insurance market and Medicare.

The rule would expand pre-enrollment verification of eligibility for special enrollment periods to curb abuses and encourage enrollment for the full year. In addition, the rule proposes allowing an insurer to collect premiums from a patient for previously unpaid coverage before the patient would be enrolled in a plan with the same insurer for the next year.

In a tweet, HHS Secretary Tom Price, MD, said that these are just the initial steps of a broader effort to fix the ACA.

My statement on today’s @CMSGov proposed reg. These are initial steps in advance of a broader effort to better serve the American people. pic.twitter.com/mAAj1re64p

— Tom Price, M.D. (@SecPriceMD) February 15, 2017

“Our commitment is to ensure short-term stability and long-term improvements,” Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, said in a statement. “While we are reviewing the details, we support solutions that address key challenges in the individual market, promote affordability for consumers, and give states and the private sector additional flexibility to meet the needs of consumers.”

However, Families USA, a patient advocacy group, had a different view. In a press release, the organization explained that the rule would discourage younger, healthier people from enrolling in coverage; reduce financial assistance; and make it harder for patients to find physicians who take their insurance.

“The Trump administration is deliberately trying to sabotage the Affordable Care Act, especially by making it much more difficult for people to enroll in coverage,” said Ron Pollack, executive director of Families USA. “By making it harder to enroll, they are creating their own death spiral that would deter young adults from gaining coverage, thereby driving up costs for everyone. “Very significantly, the administration has completely reneged on its promise to lower deductibles. Instead they are increasing cost-sharing and cutting back financial assistance for coverage.”

For the full proposed rule and all policy and operational changes, click here.