Dive Brief:
- HHS Secretary Sylvia Mathews Burwell told insurers at a forum Wednesday in Washington that the administration has been listening and responding to their concerns about operating in the ACA marketplaces, suggesting that even more changes will be forthcoming.
- Burwell's comments came as part of an effort to quell the storm around marketplace troubles, including the recent pullbacks of numerous insurers and continued failure of ACA co-ops, in the lead-up to the fourth enrollment period.
- She hinted that special enrollment periods (SEPs) are the subject of the upcoming changes and noted the administration aims to tighten control over signups outside the enrollment period.
Dive Insight:
Burwell indicated the administration is trying to make the marketplace work for insurers in order to retain them, which will be critical to sustaining the marketplaces and the varying regional levels of competition. For a growing number of consumers, competition will be down to alarmingly low levels for 2017, with monopolies growing increasingly common, particularly in rural areas.
Special enrollment periods have drawn particular attention, with insurers suggesting abuse and marketing of the process has hurt the ACA risk pool by making it easy for people to sign up when they get sick, get treatment, and then drop coverage--a move that not only costs insurers, but impacts their risk adjustment under the ACA. A report this week from Avalere backed up that assertion with its finding that special enrollment customers cost an average of 5% more and keep their policies for a comparatively short time.
Burwell told insurers the White House was hearing their concerns about the risk pool. “We want to make sure that issuers like you can sustainably serve every type of customer," Burwell said. "We also want to make sure that those who take on the highest-risk enrollees get the compensation that they need.”
The matter of the risk corridors was not addressed, The Hill noted. However, CMS has indicated it would respond to insurers' lawsuits to pay what was originally promised by the federal government, while the U.S. Department of Justice argues the money is not owed--leaving a significant financial factor wildly undetermined.