CMS on April 13 released its final rule aimed at stabilizing the individual health insurance market established under the ACA.
The agency's stabilization efforts include shortening the open enrollment period for marketplace health plans from three months to six weeks, creating stricter requirements for special enrollment periods and requiring individuals to reimburse overdue premium payments before enrolling in a new health plan.
Here are four reactions from the hospital and health insurance industry regarding the final rule.
1. America's Health Insurance Plans, one of the health insurance industry's largest trade groups, praised CMS' restriction on special enrollment requirements and greater plan flexibility, but urged immediate action from Congress to fund the ACA's cost-sharing reduction subsidies. The cost-sharing reductions help offset the price of providing discounted deductibles to low-income ACA enrollees.
Marilyn Tavenner, president and CEO of AHIP, said, "Without funding, millions of Americans who buy their own plan will be harmed. Many plans will likely drop out of the market. And doctors and hospitals will see even greater strains on their ability to care for people."
2. The American Medical Association said while it agrees the individual market must be stabilized, the final rule does not adequately address the inequity of requiring new policyholders to pay unpaid premiums for coverage lapses. AMA president Andrew Gurman, MD, said "reducing the open enrollment period to six weeks will not provide enough time for consumers to enroll, and we are concerned that moving oversight of network adequacy completely to the states will not provide sufficient protection for physicians and their patients."
3. The Association for Community Affiliated Plans, a national trade group for nonprofit safety net health plans, said improving risk pools in the individual marketplace "pale[s] in comparison to the issue of cost-sharing reduction reimbursements." Margaret Murray, CEO of ACAP, said, "insurers are putting together proposals right now for participation in the marketplaces in 2018. So long as CSRs remain a political football, health plans will raise rates — by as much as 20 percent or more — to account for that uncertainty, or they may withdraw from the market to avoid this risk."
4. Tom Nickels, executive vice president of the American Hospital Association, urged CMS to monitor implementation of the final rule and fix any coverage barriers that may arise. Mr. Nickels echoed other industry groups in stating "the most critical challenge facing the marketplaces" is the unresolved issue of the ACA's cost-sharing reductions.