The Trump administration has submitted a rule meant to stabilize the individual marketplace.
The description posted to the Office of Management and Budget Thursday offers no details and states that its content hasn't been publicly released. The policy proposal is listed as "economically significant" which means it would have an annual effect on the economy of at least $100 million.
The rule was submitted to the OMB the same day that the Senate Health, Education, Labor and Pensions Committee heard testimony from insurers who said immediate action was needed to ensure the viability of the marketplace.
Edmund Haislmaier, a senior fellow at the Heritage Foundation who worked on President Donald Trump's transition team on health policy matters, has not seen the rule but believes it aims to tighten eligibility standards for marketplace coverage and would make it harder for people to get coverage during a special enrollment period. Insurers say both issues are key to discouraging people from signing up when they realize they need costly medical services and then dropping coverage after they receive care.
While advising Trump, Haislmaier suggested a rule that bans people from gaining coverage if they owe another plan money for coverage. This was an idea he drafted after meeting with insurers during the transition. Haislmaier ultimately was not chosen to serve in the Trump administration.
Some of Haislmaier's ideas were in bills introduced this week by House Republicans as a way to stabilize the individual insurance market while they pursue repeal of the Affordable Care Act. Members of the party appear to be increasingly aware that repeal may not come as fast as they had hoped.
Insurers testifying Thursday before the Senate committee asked for immediate relief in order to remain on the marketplace and continue to provide insurance to the up to 20 million people that obtained it through the exchanges. Plans must decide by May whether to participate in the ACA marketplace in 2018. Aetna, Cigna, and Anthem all said this week that they were waiting to see more certainty in policy-making before they made their decisions.
Insurers are asking for subsidies such as the advanced premium tax credits and cost-sharing reduction payments to be paid in their entirety for the next two to three years. They also want full federal reinsurance payments for 2016. The pool of money was supposed to be paid to insurers that covered higher risk patients.
Among those who testified was Marilyn Tavenner, president of America's Health Insurance Plans. She served as CMS administrator during the implementation of the Affordable Care Act. She said it's imperative the individual mandate continue to be enforced as long as current market rules prohibit the exclusion of preexisting conditions, require guaranteed issue of insurance policies and impose community rating requirements.
The details of the rule submitted Thursday should be known relatively soon. The OMB has up to 90 days to review the proposal. Once a review is completed it's sent back to the agency that submitted it which in this case, is the CMS. The agency has historically posted a rule either the same day an OMB review ended or the next business day.
