Trump administration lets consumers skip HealthCare.gov
The Trump administration took another step Wednesday toward deregulating federal insurance exchanges created under the Affordable Care Act.
For coverage in 2018, consumers can buy an ACA-approved plan directly from a broker or an insurer's website instead of having to go through HealthCare.gov, the CMS announced. The news comes just two days after small businesses were given permission to skip the federal marketplace to sign their employees up for SHOP coverage.
"The administration does seem to be moving to privatize health insurance enrollment to a greater extent," said Larry Levitt, a senior vice president at the Kaiser Family Foundation.
It's unclear how many people could be eligible for this new path, but brokers historically sign up at least 50% of exchange enrollees.
Depending on how the policy is received by stakeholders, the Trump administration may seek out other ways to exempt people from using the federal marketplace.
"If this works very well, there will be proposals to shrink or eliminate HealthCare.gov," predicted Mark Pauly, a health economist at the Wharton School of the University of Pennsylvania.
Others say the policy has nothing to do with an attempt to shutter HealthCare.gov. "The motivation is that agents and brokers have been shown to be good at ensuring people get the most appropriate coverage," said Ed Haislmaier, a senior research fellow in health policy studies at the conservative Heritage Foundation.
The Trump administration says the goal is to help create stability in the health insurance market.
"It is common sense to make it as simple and easy as possible for consumers to shop for and access health coverage," CMS Administrator Seema Verma said in a statement. "It is time to get the federal government out of the way and give patients the best tools to make their own healthcare decisions."
As things are now, consumers either enroll themselves on the HealthCare.gov website or have a broker walk them through the site. A third route involves consumers signing up through an insurance company's or broker's website, but then being directed to HealthCare.gov to determine eligibility for subsidies and tax credits. Eventually, the applicant comes back to the web-broker's or insurer's website to finalize their coverage.
Wednesday's policy change allows people to skip the federal marketplace all together. When open enrollment kicks off Nov. 1, applicants will be able to complete the entire process, including checking on eligibility for subsidies and tax credits, on a broker or insurance company website.
"This is a great idea to make the enrollment process more efficient," said Craig Paulson, founder of the Utah-based insurance brokerage firm Altura Benefits.
Brokers have disliked having to use HealthCare.gov, saying it is cumbersome to navigate. They also face difficulty working with call center staff for the federal marketplace, who tend not to be knowledgeable about product offerings, according to Emily Bremer, a founding partner of Bremer Conley, a Missouri-based broker firm.
"You don't want to go to HealthCare.gov at all if you don't have to," Bremer said. "I have never before had so many people give me information that is 100% inaccurate."
The new policy "opens the door for web-brokers to help people who qualify for tax credits, get their prescriptions covered, keep their doctors and save money when they buy health insurance. And they won't have to leave our website to do it," Scott Flanders, CEO of web-broker eHealth, said in a statement.
Broadening distribution channels for consumers to gain coverage makes sense, said Kevin Counihan, CEO of HealthCare.gov under President Barack Obama. He cautioned that the CMS should certify that third-party vendors have the necessary administrative capabilities.
The Obama administration had raised the idea for a direct enrollment in proposed rulemaking, but it was never finalized. Serious concerns had been raised about consumers having to provide personal financial information to third parties, which creates more opportunities for that information to be vulnerable, Levitt said.
There is also potential steering to more expensive plans, according to Elizabeth Hagan, senior policy analyst with Families USA, an advocacy group. Brokers may not list all coverage options and only list those that will pay them commissions, she said.
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