- CMS on Monday released a proposed rule seeking to strengthen the health insurance marketplace for 2018.
- The rule sets payment parameters and provisions related to the risk adjustment program as well as certain cost-sharing parameters and reductions.
- The rule proposes updates for 2017 to better reflect the risk associated with marketplace enrollees who are not enrolled for a full 12 months, the agency stated.
The agency said it is releasing the rule earlier in the calendar year to "provide more certainty to the marketplace as it continues to mature." There's definitely been a fair amount of back-and-forth over the marketplace as of late as most national insurers are exiting and rethinking their exchange strategies. Dr. Uwe Reinhardt, a Princeton health policy researcher and professor, recently pontificated on the exchanges' troubles saying, "It is hard to see a way out of this dilemma, given the current political climate."
While the exchanges are in trouble (Vox recently predicted a spike in the number of counties where there is only one choice, from 182 in 2016 to 687 in 2017), that doesn't necessarily mean the ACA as a whole is failing (20 million individuals did receive health coverage through the law). However, CMS is playing the long game and working hard to stabilize and strengthen the market. For example, the agency earlier this month asked for public comment on concerns raised about providers and other organizations directing Medicare or Medicaid-eligible people toward individual market plans, including marketplace plans.
"Right now, we are preparing to serve millions of consumers with a new set of innovations during the upcoming Marketplace Open Enrollment," CMS' acting Administrator Andy Slavitt said in a prepared statement. "As we do this, we are proposing...a set of critical actions based upon our first three years' experience that, if finalized, would improve how consumers and health plans interact with the Marketplace."
Beginning in 2018, the rule proposes to establish transfers to help spread the risk of high-cost enrollees to help improve risk adjustment policies. In addition to the risk adjustment proposals, CMS is hoping to improve the consumer experience by giving individuals additional tools to assess competing plans.
"The proposed rule would also create multiple child age bands that address instances in which consumers could face large premium changes after turning age 21; amend the guaranteed renewability regulations to provide additional flexibility for issuers to remain in an insurance market in certain situations; and codify several special enrollment periods that are already available to consumers in order to ensure the rules are clear and to limit abuse," the agency noted.