Signing up for Obamacare outside of normal enrollment periods will be more difficult under a final rule released by the Trump administration.
The Affordable Care Act allows people to enroll in exchange plans outside of the normal open enrollment period if they have a life-changing event, such as the birth of a child or marriage. But health insurers and the Trump administration believe that one of the factors contributing to high claims costs for exchange plans is consumers waiting until they need health care before enrolling.
In the first quarter of 2015, claims costs for people signing up during the so-called special enrollment periods were 41 percent higher than for people enrolling during the normal open enrollment period, according to an analysis by management consulting firm Oliver Wyman sponsored by the health insurance industry.
That 2016 analysis found that special enrollment period consumers were 40 percent more likely, on average, to let their coverage lapse than were people who bought coverage during the normal open enrollment.
Under the Department of Health and Human Services’ market stabilization rule, people who want to enroll during the special enrollment periods must verify that they are eligible to do so. The change was supported by health insurers, who said it is needed to try to stabilize the marketplaces.
But ACA supporters argue that tightening special enrollment verification may backfire. A report issued in 2016 by the Obama administration HHS said attempts to require more verification resulted in a 20 percent reduction in the number of consumers signing up through special enrollment periods compared with 2015, and younger consumers are disproportionately likely to fail to complete the verification process.
“That may have an effect insurers had not hoped for,” Timothy Jost, a consumer representative to the National Association of Insurance Commissioners, told me in an interview.
The market stabilization rule includes a number of other changes intended to stabilize the marketplaces. Plans have been losing money in the exchanges and a number of health insurers, including national insurers UnitedHealth Group Inc., Aetna Inc. and Humana Inc., have pulled back from offering the plans.
Moreover, “Congress still needs to have definite action on cost-sharing reduction subsidies,” Katie Allen, executive director of the Council for Affordable Health Coverage (CAHC), told me. The CAHC represents employers, pharmaceutical companies, insurers, patient groups and physician organizations.
Providing the cost-sharing subsidies is the No. 1 priority for health insurers right now. Without the $9 billion in funding for low-income enrollees in 2017, many issuers are likely to exit the exchanges for 2018.
Read my full article here.
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