Tighter Rules on Late Obamacare Sign-Ups Contemplated


Will requiring people to verify their eligibility for enrolling in health-care plans late reduce claims costs, or will it lead to even fewer young adults signing up in the Obamacare exchanges?

That’s a question the Trump administration is probably about to find out. One of the first rule proposals to be issued since President Donald Trump took office Jan. 20 is under review by the Office of Management and Budget.

While it isn’t certain what is in the proposed rule from the Centers for Medicare & Medicaid Services, health care lobbyists believe it likely includes a number of policies called for by health insurers to stabilize the unprofitable Affordable Care Act exchanges, which have experienced premium increases averaging 25 percent and declining competition in 2017.

The top rule change is expected to be requiring people who sign up for health-care plans outside of normal enrollment periods to prove their eligibility before being enrolled. Such special enrollment periods are supposed to only be used for events such as marriages or births.

But a 2016 study sponsored by health insurers found that health-care costs were 24 percent higher for people who enrolled through special enrollment periods during the first three months of 2014 than for people coming in during the normal open enrollment period.

That could indicate people are waiting until they have medical needs before buying insurance, sort of like waiting until your house is on fire to buy fire insurance.

But liberals who support the ACA say many people who are eligible for special enrollment periods aren’t taking advantage of them, and requiring people to submit more paperwork could discourage young, healthy people.

“When they tried to tighten up on eligibility, it was young people who went away, not the old people,” Timothy Jost, a consumer representative with the National Association of Insurance Commissioners, told me, citing a December 2016 Department of Health and Human Services report.

In addition to changes in special enrollment procedures, the proposed rule is likely to tighten rules for the 90-day grace period the ACA requires insurers to provide coverage to people who haven’t paid premiums.

One suggestion from the Council for Affordable Health Coverage, which represents employers, insurers, health-care providers and patient groups, is to withhold coverage from people until they pay outstanding premiums.

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