Insurance companies are calling on the Trump administration to rethink a proposal to shorten the open-enrollment period over their fears that it will result in only the sickest individuals signing up for coverage.
Several insurers and providers including Kaiser Permanente weighed in on a Trump administration proposed rule aiming to stabilize the individual marketplace created by the Affordable Care Act, voicing concerns about several provisions of the wide-ranging rule. The CMS received more than 2,500 comments on the proposed rule before the deadline passed on Tuesday.
The rule, issued last month, contained provisions that would shorten the ACA's open-enrollment period by six weeks, shift authority to states to determine whether health plans have adequate provider networks, and give insurers more flexibility in covered benefits.
The rule also proposed to shorten the enrollment period for 2018. Instead of lasting three months, it will run for six weeks, starting on Nov. 1 and ending Dec. 15. That would allow consumers' coverage to begin Jan. 1 for a full calendar year, and makes it easier to process enrollment since all policies would begin Jan. 1. It is also expected to improve the risk pool, the CMS said.
Kaiser Permanente said in a comment posted on March 6 that this proposal could actually reduce plan sales, which would impact the overall risk pool and could result in higher premiums.
If the Trump administration does decide to move forward with the idea, Kaiser suggested that open enrollment begin two weeks earlier to accommodate issuers' need to process enrollees during an abbreviated open-enrollment period.
MVP Health Care, a plan that insures people in upstate New York and Vermont, said a shortened open enrollment would likely discourage healthier people from signing up for coverage. Internal plan data from MVP suggests that enrollees who signed up in January and had a Feb. 1 effective date, were healthier on average than those with a Jan. 1 effective date.
If the CMS finalizes the proposal, the federal regulator should give states the flexibility to decide if they want to implement a shorter enrollment period, MVP said.
The proposed rule also would allow insurers to refuse coverage to individuals who miss premium payments until they pay those bills. Centene Corp. urged the Trump administration to go further with that proposal. The payer supported implementing a 12-month continuous coverage provision, which would require consumers to provide proof of continuous coverage for the year prior to enrolling in a new plan or with a new issuer.
This revision would help mitigate the risk that consumers are only enrolling in coverage because they have fallen ill while still allowing those who need coverage to obtain it, Centene said.
In addition, the proposed rule would eliminate redundancies in the current network advocacy requirements. Insurers currently must meet both federal and state standards on network adequacy, but the proposal would shift the review to just the states. That change was expected to reduce administrative burdens for plans.
Plans praised this proposal in comments to the agency, but groups like the American Medical Association warned it would put patients at risk.
“The proposed rule would undo progress made toward ensuring adequacy of provider networks, and, as a result, will impede access to care for patients,” the trade group said. “In efforts to reduce premiums, insurers are increasingly narrowing their provider networks. As a result, strong network adequacy requirements and regulations are more important than ever.”