The Biden administration is proposing several changes aimed at boosting access to high-quality, affordable health insurance through Affordable Care Act marketplaces, according to a proposed rule released Monday.
CMS wants to give people an additional 30 days to enroll in marketplace plans by expanding the annual enrollment period. It currently starts on November 1 and ends December 15, but the new plan would give people until January 15 to enroll in coverage beginning in 2022. The agency also plans to establish a monthly special enrollment period to allow people with low incomes more opportunities to enroll in a premium-free silver plan.
In addition, the proposed rule would reinstate requirements that ensure ACA navigators educate consumers and assist them with some post-enrollment topics, including the eligibility appeals process and how to use their coverage.
"These proposed changes would provide consumers greater access to coverage through, for example, greater education and outreach, improve affordability for consumers, reduce administrative burden for issuers and consumers, and improve program integrity," the proposed rule said.
Comments on the proposed rule are due July 28.
CMS also wants to end a Trump-era policy that allows states to privatize their marketplace exchanges by enabling consumers to buy marketplace plans directly from insurance companies and brokers instead of going through a federal- or state-based exchange. The agency signed off on the current policy in January, shortly before former President Donald Trump left office, and after it gave Georgia an exemption to pursue a similar plan.
Under the Trump administration, CMS had argued the policy could lower healthcare spending by encouraging competition among insurers and lowering premiums for consumers. But critics of the privatization plan said it would confuse consumers and that brokers might take advantage of consumers by steering them into more profitable plans.
CMS said revoking the option shouldn't have many real-world effects since no state has expressed interested in pursuing it yet. The Biden administration is reviewing Georgia's waiver.
In addition, the proposed rule would revoke the Trump administration's 2018 guidance on Section 1332 waivers, which allow states to experiment with new ways of providing coverage through ACA marketplaces. The Biden administration said the 2018 guidance could lead to coverage losses and worsen health disparities.
"The departments also encourage states to develop waiver proposals that diminish barriers to opportunities and benefits such as health insurance coverage for people of color and other underserved groups. For example, states may include waiver programs that increase plan options for comprehensive coverage, reduce premiums, improve affordability, as well as address social determinants of health," the rule said.
The agency also plans to increase marketplace user fees, increasing them from 2.25% to 2.75% of premiums for federally-facilitated marketplaces and from 1.75% to 2.25% state-based exchanges.