Privately Run Obamacare Enrollment Pushed for 2018

Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

By Sara Hansard

People will be able to enroll in Obamacare plans directly through web brokers and health insurers for 2018, which will reduce the need for federal outreach funds.

That feature will likely be included in an upcoming Department of Health and Human Services proposed rule under review at the Office of Management and Budget, Joel White, president of the Council for Affordable Health Coverage (CAHC), told Bloomberg BNA Sept. 22. Congress isn’t likely to provide more funding for Affordable Care Act outreach activities, so “HHS is going to have to figure out ways to expand options for consumers to get enrolled,” White said HHS officials have told his group. The CAHC is a broad-based group of health-care industries.

Pro-ACA groups have complained that big cuts in exchange advertising and outreach activities announced in August will undermine the exchanges. The HHS is emphasizing that it’s in the interest of the private companies that sell exchange plans to take responsibility for getting their customers enrolled. The 2018 open enrollment is scheduled for Nov. 1 through Dec. 15. Some 12.2 million people enrolled in ACA plans for 2017.

HHS Official Outlines Plan

Randy Pate, director of the Center for Consumer Information and Insurance Oversight (CCIIO) at the HHS, met with members of the CAHC Sept. 21, according to people who attended the meeting. Pate outlined several policies that are likely to be included in the 2019 Notice of Benefit and Payment Parameters proposed rule, which covers rules for the ACA exchanges. An HHS spokesman, who replied to Bloomberg BNA on condition of anonymity, said he didn’t have information on what is in the proposed rule.

The proposed rule will codify guidance issued in May by CCIIO that would allow web brokers and health insurance carriers to use a proxy direct enrollment pathway to determine premium tax credit eligibility for exchange enrollees, according to people who attended the meeting.

In addition, Pate told the CAHC group that the HHS is likely to have a stand-alone eligibility enrollment service for the open enrollment period for 2019 calendar year plans, according to a participant at the meeting. Such a system would allow web brokers and health insurance carriers to get direct premium tax credit eligibility determinations for enrollees.

Subsidy Determination Systems

eHealth Inc., the largest health insurance web broker, used a “workaround” system to enroll people in for the 2015 and 2016 plan years, John Desser, senior vice president of government affairs for eHealth, told Bloomberg BNA Sept. 22. With the workaround, enrollees didn’t have to use to determine their subsidy eligibility. Using that system, eHealth was able to enroll many young people, he said. eHealth enrolled about a half-million people during the first two years of the ACA exchanges, he said. eHealth is a member of the CAHC.

But for the 2017 plan year, the Obama administration barred web brokers and carriers from using the workaround, Desser said. That meant people enrolling for ACA plans had to go directly to to determine their eligibility for premium tax credits. During open enrollment in fall 2016, eHealth didn’t enroll anyone who was eligible for the tax credits, Desser said. “They needed more younger enrollment, and they shut down the channel that was giving them younger, healthier enrollment,” he said.

The exchanges have suffered from not being able to attract enough young, healthy people to balance older, sicker people, which has resulted in losses to insurers operating in the exchanges and a likely spike in premiums for 2018.

Small Business Enrollment

In addition to codifying the guidance allowing web brokers and carriers to use the proxy direct enrollment system, the upcoming Notice of Benefit and Payment Parameters proposed rule is likely to announce that the HHS is working on a plan that would allow small businesses to enroll in small group health plans and apply for the ACA small business tax credits without having to use the Small Business Health Options Program (SHOP) exchanges, Pate and Desser said.

Few small businesses have used the SHOP exchanges because they typically use brokers to help them set up employee health plans. Moreover, the small business tax credit has not been widely used because it is complicated and businesses have had to enroll through the SHOP exchanges to be eligible for it.

State Waiver Flexibility

The proposed rule also is likely to contain a provision that repeals at least parts of the Obama administration’s restrictions on the Section 1332 state innovation waivers, Pate said. States and congressional Republicans have called on Congress and the administration to make it easier for states to get the waivers.

The waivers can be used to change major parts of the ACA, such as essential health benefit coverage requirements, as long as states can demonstrate to the HHS that they are covering as many people with coverage that is as comprehensive and affordable as would have been the case without the waivers, and as long as the waivers don’t increase the federal deficit.

One of the difficulties of the Obama administration’s 1332 rule was it required states to demonstrate that the waivers would save money each year, even though the waivers are for five-year periods, Pate said. Alaska and Hawaii have received the waivers, and Minnesota, Iowa, Oklahoma, and Oregon have applied for them.

To contact the reporter on this story: Sara Hansard in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at

For More Information

The Office of Management and Budget's notice of review for the CY 2019 Notice of Benefit and Payment Parameters proposed rule is at

The CCIIO's Policies Related to the Navigator Program and Enrollment Education for the Upcoming Enrollment Period is at

The CCIIO's Proxy Direct Enrollment Pathway for 2018 Individual Market Open Enrollment Period is at

Information on the Section 1332 state innovation waivers is at

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

Request Health Care on Bloomberg Law