With attempts to stabilize the individual market through legislation at an impasse, major insurance companies, including Centene, Cigna and the Blue Cross and Blue Shield Association, say there are things that can be done by HHS administratively to bolster the insurance marketplaces.
Payers are still most interested in getting assurances that cost-sharing reductions will continue and the individual mandate will be enforced, but given the political controversy surrounding those requests, they've also outlined other requests that won't require congressional action.
The suggestions can be found in a series of letters posted Friday on the Federal Register's website in response to a CMS inquiry on how it can reduce the ACA's regulatory burden.
The health insurance industry requests range from altering the enrollment process to making it easier to change which drugs are covered, while hospital industry advocates chimed in with their own recommendations as how to bolster coverage with tweaking.
Centene, which sells marketplace coverage in 11 states, would like the renewal process to be strengthened. Due to the proposal to shorten the enrollment period from the usual three months to six weeks beginning Nov. 1, the company wants auto-renewal notices to be issued as early as possible.
Currently, the earliest issuers are allowed to send out renewal materials to members is with their January invoice, which is sent in early December.
"Given the shortened time frame for consumers to be able to switch plans, sending out a member's renewal packet in early December does not allow enough time for a consumer to change plans if they find the plan they are renewed into no longer fits them," Jonathan Dinesman, senior vice president of government relations, said in a letter.
He requested that issuers be allowed to send renewal packets in November as well as being allowed to draft their own renewal letters rather than using a boilerplate template provided by HHS as those notices are hard for the consumer to understand, he said.
Cigna, which operated on ACA marketplaces in seven states this year, wants more say on how often changes can be made to prescription drug coverage.
Federal guidance now generally limits issuers' ability to remove drugs, move drugs to a higher cost-sharing tier, or limit access to a drug during a plan year.
"This flexibility will allow issuers to better negotiate prices with pharmaceutical manufacturers and enhance prescription drug affordability," David Schwartz, head of global policy at Cigna, said in a letter.
The Blue Cross and Blue Shield Association, which represents 36 plans across the country, is requesting the CMS reissue and finalize a December 2016 rulemaking that limited the list of entities from which issuers are required to accept third-party premium payments.
The rule should also be broadened to prevent healthcare providers, manufacturers or the interest groups and foundations that they support from steering individuals who are eligible for Medicare and Medicaid to private coverage. "Such steering may cause harm to consumers if, for example, premiums are not paid all year," Kris Haltmeyer, vice president of health policy at the association, said in a letter.
The American Hospital Association, in addition to pushing for the funding of CSRs, asked the CMS to take administrative actions such as expediting the approval of state-driven approaches to stabilizing marketplaces and phasing out grandfathered-in transitional health plans where they still exist.
It's unclear which if any of the ideas will be embraced by HHS, as it didn't outline a time line in its request to stakeholders on how to reduce regulatory burden.
During an appearance on ABC Sunday, HHS Secretary Dr. Tom Price did however outline the metric he would use when determining which rules he would scuttle.
"We're going to look at every single one of those rules and regulations, all 1,442 of them, and determine does it drive up costs? Does it drive down costs? Does it help patients? Does it hurt patients?" Price said. "And when it drives up costs and hurts patients, we're going to move in the other direction."
