The government is offering some ideas to try and fix the Affordable Care Act (ACA), also known as Obamacare, amid a series of missteps that have befallen President Barack Obama’s signature legislative achievement.
After being dogged by negative news for the last few weeks — from major insurers pulling out of state exchanges to regulators saying the exchanges are “near collapse” — the Center for Medicare and Medicaid Services (CMS) proposed a series of changes Monday to try and correct some of the exchange issues.
CMS, which is the division of the Department of Health and Human Services that oversees the exchanges, proposed tweaks that would make it less risky for insurers in the marketplace to take on sick patients and a number of outreach attempts.
Two of the biggest problems for the exchanges have been the lack of young people signing up for insurance, which helps offset higher costs patients, and generally sicker-than-expected people getting coverage through the exchanges, leading to huge losses for insurers.
Kevin Counihan, the insurance marketplace CEO at the center, said these changes would fix a number of issues with the exchanges.
“These proposed actions and others we have taken over the last six months would help to: support issuers with high-cost enrollees, while updating risk adjustment; strengthen the risk pool; promote additional enrollment; and support issuers in entering the Marketplace or growing their Marketplace business,” Counihan wrote in a post summarizing the proposals.
A few of the 14 total proposals include:
- Using some of the fees from the Federally-funded marketplace for outreach to get more young people to sign up.
- Strengthening rules for signing up for insurance outside of the open enrollment period to ensure people are not waiting until they are sick to get coverage.
- Take prescription drug use into account when evaluating the risk profile of potential patients. Previously, this had not been taken into account and insurers argues it prevented them from getting a full picture of possible patients’ health status.
- Requiring insurance companies that offer a bronze plan in an exchange (the lowest level of coverage) to also offer a silver and gold-level plan.
All of these changes serve as attempts to make it more economically sound for insurance companies to be in the market, to get more people into the exchanges (roughly 11% of Americans are still uncovered), and to eliminate loopholes that allow people to game the exchanges.
The exchanges are just part of the ACA, and represent only 6% of health-insurance coverage nationwide. But, as one of the signature parts of the law, their survival is a huge deal to the long-term future of the ACA.
Comments on the proposals close on October 6.