Amid Market Uncertainty, Trump Administration Retreats from Health Plan Oversight

By Justin Giovannelli and Kevin Lucia

Congress may or may not repeal key provisions of the Affordable Care Act (ACA). But under the guidance of the Trump administration, the way the health law works, in practice, has already changed. Along with threats to cut off federal payments for plans that offer reduced cost-sharing and an executive order casting doubt on enforcement of the law’s individual mandate, recent regulatory actions reduce federal oversight of marketplace health plans, passing responsibility to the states for ensuring compliance with federal consumer protections.

In mid-April, the Trump administration announced it would stop monitoring marketplace plans for compliance with several important federal protections and instead defer to state oversight. The administration’s hands-off approach effectively:

  • Rolls back federal oversight of provider networks and eliminates specific quantitative standards for judging whether plans’ networks are sufficient;
  • Relaxes oversight of federal rules prohibiting marketplace plans from picking and choosing the geographic locations they serve in ways that discriminate;
  • Weakens federal requirements for plans to provide access to “essential community providers,” like safety-net hospitals and community health centers, which serve predominately low-income, medically underserved individuals;
  • Ends federal review of marketplace plans’ prescription drug formularies in certain states, deferring instead to those states to determine whether a plan is using a discriminatory benefit design.

In their latest blog post for The Commonwealth Fund, Justin Giovannelli and Kevin Lucia explain the new changes to insurance oversight, and assess the potential impact of this federal deregulation for consumers and states.

Read the full post here.

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