ACA Marketplace Update

Filing extension may not be enough to keep insurers in individual market

Health insurers are pleased the Trump administration wants to give them seven extra weeks to file rates for individual-market plans in 2018. 

But that move does little to settle their uncertainty about whether to offer plans at all. Their anxiety has been heightened by the Republican drive to repeal and replace the Affordable Care Act and by a pending House Republican lawsuit to block certain payments to insurers. Carriers say they need to know the rules of any new system before they can design plans and set rates.

In a draft notice posted Friday, the CMS said it would revise rate-filing deadlines for all health plans currently selling products on the ACA's exchanges. It's pushing back the deadline for filing applications and rates from May 3 to June 21. 

The notice “will likely give insurers more time to sort out some of the short-term uncertainty in the market,” said Margaret Murray, CEO of the Association for Community Affiliated Plans. But, she added, the Trump administration and congressional Republicans need to decide quickly whether they will pay insurers for the ACA's required cost-sharing reductions for lower-income consumers.

To that end, House Republicans filed a joint motion with the U.S. Justice Department Tuesday to delay their legal case seeking to block payment of the cost-sharing reduction funds. If the federal appellate court grants the motion, the parties would have until May 22 to file a status report with the court and establish 90-day deadlines after that.

If cost-sharing reduction payments end, Congress would have to act immediately to appropriate funds or else insurers would have to shoulder the cost. Those federal cost-sharing reduction payments to insurers totaled $4.9 billion in 2015, Murray said.

House Republicans argue that the Obama administration illegally funded the cost-sharing subsidies without a congressional appropriation. But now they are feeling pressure to back off the litigation because it could disrupt the insurance market. So far, however, neither the Trump administration nor congressional GOP leaders have offered legislation to fund the cost-sharing reduction payments.

It's widely anticipated that if the payments cease, many insurers would immediately leave the individual market if their contracts allowed them to do so. 

“Their interruption would sow havoc in the marketplaces, and their discontinuation would be an extinction-level event for many qualified health plans,” Murray said.

Until that issue is resolved, the extra time for filing 2018 rates provides little comfort. "Plans are eager to get clarity regarding subsidies for next year,” said Ceci Connolly, CEO of the Alliance of Community Health Plans, which represents not-for-profit insurers. “Without that, it is nearly impossible to develop sound pricing.”

Cori Uccello, a senior health fellow of the American Academy of Actuaries, agreed. “The extended timeframe is less helpful if uncertainty about policymaking continues,” Uccello said.

A key benefit of the rate-filing extension is that it will give plans a chance to review their first quarter performance with enrollees who signed up during the recent open enrollment period, according to a spokesman for the National Association of Insurance Commissioners.

Insurers have said there's too much uncertainty arising from GOP efforts to repeal and replace the ACA for them to decide whether to stay in the individual marketplace, through which nearly 20 million Americans get their insurance. After an exodus of some large commercial carriers such as UnitedHealth Group, remaining insurers have said they wanted to see some changes to bring more young and healthy people into the market and stabilize the risk pool.

Insurers say policymakers must resolve the cost-sharing reduction payment issue and preserve the requirement for individuals to buy insurance. Those, they say, are the key issues determining whether they stay in the market in 2018.

In its notice Friday, the CMS announced it's pushing back other timelines, including the June 13 deadline to correct applications. Insurers now will have until Aug. 2.

The agency will send its final certification notices to insurers by Oct. 12 instead of Sept. 22. 

The delay notice was expected given that the Trump administration released a proposed rule last week outlining a number of incremental changes to the individual market. 

The CMS is taking public comments on the proposed rule issued last week and on the rate-filing extension. Those comments are all due by March 7.


Modern Healthcare Article

Tags: aca, marketplace, Obamacare

Log on to Your Rise Account

Forgot your password?
Create an Account

Association Sponsors

Latest Posts

Keep M.E.A.T. on Your List for a Healthy Audit

By Jeanmarie Loria, Advize Health, LLC If you’re reading this article, chances are you already know what HCC Coding is – but we’ll give you a refresher anyway. Hierarchical Condition Category (HCC) and Risk Adjustment Coding is a CMS-mandated payment model. This model works to identify those with chronic and other serious illnesses and prescribes a risk factor score to each patient, taking into consideration their ailments and other demographics. With every payment model comes a specific set of audit and review requirements that must be met to maintain the integrity of the system, and this is where MEAT (Monitor, Evaluate, Assess/Address, Treat) comes in handy. In a face to face visit M.E.A.T. maybe found in the chief complaint, history of present illness, review of systems, physical exam, assessment and/or plan....
Read More

Getting It Right: True North in Healthcare Reform

The movement to repeal and replace "ObamaCare" created so much political noise that clear thinking has been hard to come by. The 2010 legislation that created the marketplace for individuals and small business (the Affordable Care Act or ACA), has almost evolved into a political Rorschach test. The more that politicized options and alternatives to repealing, replacing, or repairing it were discussed, the harder it was to put into focus the original problems the legislation was designed to address. Nevertheless, the rancorous divisions over what needs to happen to fix problems in the individual insurance market remain a distraction from the real issue at hand: the cost of healthcare weighing down the economy and what we need to do to fix it. With all the intense debates swirling around this topic, an impression emerges that “solving the ObamaCare issues” is something that must be accomplished as an isolated matter, discrete and independent of other problems. The heated debates concentrate on the mechanics and tactics required to solve the "uninsured problem", the "under-insured problem", and for some, the federal budget problems created by the subsidies for low-income enrollees in these plans. This single-issue mono-vision obscures a reality that must be addressed. This perspective completely misses the fact that something is going on that is far more corrosive to the wellbeing of all of us as consumers of health care, as taxpayers, and as a nation: something that overshadows the tug ‘o war over ObamaCare. The critical and overlooked issue is that health care expenditures in the U.S are at least twice as expensive as other nations, which consume so much of the national economy...
Read More

Upcoming Conference


Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.


Upcoming Webinar

Successful and Meaningful Techniques for Integrating Risk and Quality Interventions

Quality measurement and risk adjustment regulations are increasing and the financial impact upon health plans is progressively driving accountability and influencing profitability through payments, penalties, and bonuses. To improve performance and optimize risk and quality payments, Health Plans need to streamline processes, employ best practices for data capture, and focus on strategic interventions that use a member-centric approach.  

Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.