The CMS has made a handful of final changes to the Affordable Care Act's health insurance marketplaces for 2018, just a little more than a month before Donald Trump takes over the White House and congressional Republicans move to repeal the healthcare reform law.
A final rule published late Friday cements many of the CMS' proposals from August. Some of the most notable changes involve the ACA's permanent risk-adjustment program, which funnels money from insurers with lower-cost enrollees to companies that have higher-cost enrollees.
For example, risk adjustment for exchange plans will now factor in the effects of people who are enrolled for only part of the year and prescription drug data will be included in its complex formula. The CMS proposed those changes this year after many insurers complained risk adjustment was heavily flawed.
More than 4 million people signed up for health coverage through the HealthCare.gov exchanges as of Dec. 10, and the government extended the deadline for Jan. 1 coverage to Dec. 19 because of an uptick in enrollment.
Republicans have not coalesced around a plan to replace the ACA, leaving many wondering if it will be years before the law is changed or simply rebranded. Policymakers view changes to the exchanges in 2018 as vital, especially if the hope is to prevent health insurance companies from leaving the marketplaces due to the uncertainty, which would toss millions of people off their health coverage.
“The administration will leave the marketplace on a stable path that, when fully implemented, will ensure quality coverage is available for all Americans well into the future,” CMS acting Administrator Andy Slavitt said in a news release.
Friday's final rule is not the federal government's only major update to the individual exchanges as of late. Earlier this month, the CMS implemented a rule to stop providers, like dialysis centers, from signing patients up for private exchange coverage when those people are eligible for Medicare or Medicaid.
The CMS also said it is starting a pilot project this summer that will attempt to crack down on people gaming the special enrollment periods, which allow people to buy coverage outside of open enrollment under certain circumstances, such as moving or having a child.
