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August 24, 2016 12:00 AM

American Hospital Association calls for changes to exchanges

Maria Castellucci
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    The American Hospital Association has warned the Affordable Care Act marketplaces lack stability as insurers exit and concern over drastically rising premiums continues.

    In an open letter to HHS Secretary Sylvia Mathews Burwell on Wednesday, AHA President and CEO Richard Pollack urged the agency to make several policy and operational changes to “stabilize the insurance markets and encourage robust consumer and insurer participation.”

    That participation could be jeopardized by several insurers' recent announcements they will pull out of ACA's exchanges. Those changes “will require millions of consumers to find new coverage in 2017," Pollack wrote.

    Insurance giants Aetna, Humana and UnitedHealth Group have all said they will drastically scale back participation in plans as they continue to suffer losses.

    According to the AHA, the key to marketplace stability is “enrolling healthier individuals,” and HHS should take several steps to further this goal.

    The group suggested HHS strengthen special enrollment periods by pre-approving their use before the enrollment period begins and implementing consumer protections so those eligible for special enrollment can effectively use their coverage and understand their payment responsibility.

    The AHA also supported finalizing changes to the ACA's risk-adjustment program, including use of prescription drug data to help identify diagnoses.

    Another area of focus for the AHA was enhancing enrollment on the exchanges. The association said many low-income Americans still can't afford the premiums of plans, and suggested HHS allow hospitals and systems to cover part of the premiums for individuals not eligible for Medicare and Medicaid. The feds asked the healthcare industry last week to submit information about whether hospitals, providers and foundations were steering Medicare- or Medicaid-eligible patients toward the exchanges in order to obtain higher reimbursement rates.

    HHS declined to comment on the letter but noted several efforts to stabilize the markets. The agency released an analysis Wednesday that showed premium increases for 2017 plans will still be affordable, although many caveats apply.

    AHA also insisted the CMS work more with states to develop solutions that will encourage more stability, noting Alaska authorized a state-level reinsurance program with success.

    The letter addressed the reportedly skyrocketing premium prices expected on the 2017 exchanges.

    “While recent announcements of double-digit premium increases are alarming, we have reason to believe that such increases may be a one-time correction and necessary to stem insurer losses moving forward," Pollack wrote.

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    • News
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      • Transformation
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      • ESG
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      • Regional News
        • Midwest
        • Northeast
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      • Digital Edition (Web Version)
    • Blogs
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      • HIMSS 2023
    • Opinion
      • Breaking Bias
      • Commentaries
      • Letters
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - AI and Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
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      • Hospital Financials
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