The Centres for Medicare and Medicaid Services rolled out its final rule for the 2018 Obamacare exchanges on Thursday.
The final rule, an update of changes proposed on February 15, would make a variety of changes, 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 stabilise the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options,” acting CMS Administrator Patrick Conway 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.”
On the other end of the political spectrum, Democrats quickly blasted the changes.
Rep. Frank Pallone, the ranking Democrat on the House Energy and Commerce Committee, said that 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 would continue to spend money on outreach to encourage people to sign up. But the shorter enrollment period — going from November 1, 2017 to December 15, 2017 — will likely result in lower enrollment.
- Allow insurers to collect for unpaid premiums before they sign up with the same insurer the next year: The CMS release says the rule “will incentivise patients to avoid coverage lapses.” It could also discourage those that 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 of the open enrollment period: In order to limit the number of people that drop coverage and only enroll when they need it, the CMS rule would force people to give more identification in order to sign up for the exchanges outside of 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 per cent of medical costs a plan would cover. The rule would allow insurers to adjust their actuarial value while still qualifying for the exchanges. In the worst case, that could mean consumers would end up with plans that cost close to the plans offered on the exchanges currently, but also cover fewer procedures.
Even with the changes, it is still unclear whether the Trump administration will fund cost-sharing reduction payments, which most policy analysts say is key to keeping the market from collapsing.
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