CMS on Thursday significantly changed how Affordable Care Act exchanges will run, including allowing states to waive some requirements and to use web-based brokers to sell insurance by 2023, moves that insurers and other industry groups have said would essentially privatize the exchanges.
In its annual benefit and payment parameters rule, the agency said states will be able to use Section 1332 waivers to individualize their exchanges and eliminate some statutory requirements. States will be allowed to add web-based brokers as the primary way that residents enroll in individual market plans. The agency put the onus on states to ensure those brokers and insurers meet any eligibility requirements.
In its proposed rule, CMS said the exchange changes would foster competition among insurers and help lower premiums.
For its part, CMS dropped user fees for plans on the federal exchange from 3% to 2.25% of the plan's premium. The said these reductions have contributed to an 8% average premium reduction across the federal exchanges since 2018, and it plans to lower the state-based exchange user fee in a separate final rule.
The final rule also waives network adequacy requirements for plans that don't use provider networks to determine the benefits they pay.
More than 170 commenters weighed in on the changes after they were proposed in November, with many claiming the move could force millions of Americans to use private brokers who may have conflict of interest as they promote some coverage. The Alliance of Community Health Plans worried that brokers and insurers would steer low-income consumers toward private, substandard plans without explaining they were eligible for Medicaid.
"The AMA is concerned that continuing on the path of privatizing the exchange with which millions of consumers are familiar and through which most consumers enroll could make it harder for people to find high-quality, ACA-compliant insurance with full benefits and could reduce overall enrollment," the American Medical Association commented in December.