The Trump administration is trying to pull off an odd trick: satisfying the concerns of health insurers to stop them from fleeing the Affordable Care Act exchanges while also working to discredit and unravel the law.
Days after Congress confirmed Dr. Tom Price as HHS secretary, the CMS issued a proposed rule intended to stabilize the marketplaces and appease insurers, particularly their concern that it's too easy for people to sign up for coverage only when they need healthcare services.
“Given the emergency caused by Obamacare's damage to our healthcare system, it is essential that action be taken as soon as possible to provide some immediate relief to the American people,” Price said in a statement about the proposed changes. “These are initial steps in advance of a broader effort to reverse the harmful effects of Obamacare, promote positive solutions to improve access to quality, affordable care, and ensure we have a healthcare system that best serves the needs of all Americans.”
The White House appears to be trying to buy time while Congress attempts to coalesce around a plan to replace the Affordable Care Act. To get the changes finalized as quickly as possible, the rule has a shorter-than-usual comment period. Insurers and other industry stakeholders have until March 7 to seek changes in the regulations.
The draft failed to address the insurance industry's most pressing concerns. “Right now, plans are missing key pieces of information to make smart business decisions for 2018,” said Ceci Connolly, CEO of the Alliance of Community Health Plans. Most need to decide by March whether they'll stay on the exchanges.
One key issue that's not addressed is the individual mandate, the ACA's primary mechanism for creating a balanced risk pool. The mandate is considered imperative as long as the law continues to prevent insurers from rejecting consumers with pre-existing conditions. Insurers also say they need a commitment from the administration that they will continue to receive payments for cost-sharing reductions that exchange plans are required to extend to lower-income enrollees.
None of that was addressed in the proposed rule. The Internal Revenue Service, meanwhile, announced it would not reject tax returns that fail to respond to questions about healthcare coverage. The IRS was following an executive order that President Donald Trump signed on Inauguration Day. It directs federal agencies to “exercise all authority and discretion ... to waive, defer, grant exemptions from, or delay the implementation of any provision” of the ACA that would impose a cost or regulatory burden on Americans.