Earlier this year, the Department of Health and Human Services (HHS) requested comments on how it could reduce regulatory burdens under the Affordable Care Act to achieve the following four goals:
- Empower patients and promoting consumer choice;
- Stabilize the individual, small group, and non-traditional health insurance markets;
- Enhance affordability; and
- Affirm the traditional regulatory authority of the states in regulating the business of health insurance.
These comments may be used to inform future rules and guidance, including an annual regulation that sets rules for the marketplace risk sharing programs and participating health plans, known as the “Notice of Benefit and Payment Parameters.” HHS will likely publish a draft version of that rule sometime this fall.
- American Cancer Society Cancer Action Network (ACS CAN)
- Center on Budget and Policy Priorities (CBPP)
- Families USA
- National Health Law Program (NHeLP)
- National Immigration Law Center (NILW)
- National Partnership for Women & Families (NPWF)
- Young Invincibles (YI)
Goal 1: Empower patients and promote consumer choice
One request of the consumer advocates has already been rejected by the administration. Most of the above organizations called upon the administration to continue investing in outreach and consumer support by fully funding the Navigator programs at levels comparable to prior years and to continue enrollment advertising and outreach, particularly during open enrollment. The administration, however, has decided to cut funding for outreach by 90 percent from the previous year and Navigator funding by about 40 percent.
Other suggestions include continuing to offer and to improve upon consumer shopping tools like the doctor and prescription drug look-up tools, to expand and improve plan comparison tools related to network adequacy breadth and quality ratings that are currently being piloted in certain states, and to continue the standardized or “simple choice” plans to enable consumers to more easily compare plans. Consumer advocates also suggested maintaining the comprehensive nondiscrimination protections under Section 1557 to protect consumers.
Many consumer advocates also urged the administration to monitor recent policy changes under the Market Stabilization rule like the shorter open enrollment period for 2018 coverage and restrictions on special enrollment periods and to make adjustments as necessary; for example, by lengthening open enrollment if there are high volume or system delays. Half of the comments of the consumer advocates we reviewed also called upon the administration to work with insurers to encourage and maximize marketplace participation to avoid bare counties.
Goal 2: Stabilize the individual, small group, and non-traditional health insurance markets
Comments from all eight consumer advocacy organizations encouraged the administration to continue making cost-sharing reduction (CSR) payments. Groups like the ACS CAN, CBPP, and Families USA suggested that publically committing to long-term CSR funding would ease the insurer uncertainty that’s causing many insurers to increase premiums for 2018 coverage or scale back marketplace participation.
Similar to insurer and state comments, many consumer advocates recommended that the administration commit to enforcing the individual mandate by clearly communicating the consequences of not enrolling into coverage, particularly as the upcoming open enrollment period is scheduled to begin. Several consumer advocates encouraged the administration to continue working with states to encourage more use or Section 1332 waivers to establish state reinsurance programs, citing Alaska’s program as an example.
Goal 3: Enhance affordability
Consumer groups agreed that maintaining the current requirement to provide essential health benefits was an important provision to enhance the affordability of coverage. Groups like AARP, NILC and NPWF all indicated that any weakening of the EHB provision could lead to higher out-of-pocket costs for consumers and benefit design that discriminate against consumers with pre-existing conditions. Moreover, they argue, ensuring comprehensive coverage, including maternity and mental health services, would help attract younger adults that could shore up the stability of the marketplace risk pools.
Consumer advocacy groups like CBPP, Families USA, NILC and YI encouraged the administration to take a comprehensive view of affordability and consider out-of-pocket costs and benefit designs. NHeLP further recommended that the administration discourage the use of coinsurance and high deductibles as a way to enhance the affordability of coverage.
CBPP, Families USA, and NHeLP also encouraged the administration to continue limiting short-term limited duration (STLD) policies that offer little coverage or financial protection to consumers, and also siphon off healthy consumers from the marketplace.
Goal 4: Affirm the traditional regulatory authority of the states in regulating the business of health insurance
Not all of the comments from the consumer advocacy groups we reviewed had suggestions for this last goal, but the groups that responded overwhelmingly reiterated the importance of having a federal floor of protections and state flexibility to build above that floor. Some opposed the sale of insurance across state lines and association health plans, both of which would preempt states’ regulatory authority and undermine state consumer protections.
Take-away: The top recommendation of consumer advocacy organizations is to permanently fund cost-sharing reduction payments. Insurers and state officials had the same recommendation, reflecting remarkable consensus across diverse groups. Consumer advocates also emphasized the importance of investing in Navigator programs and marketplace advertising as ways to promote choice and stabilize the marketplaces. Consumer advocates further encouraged the administration to look not at just premiums, but out-of-pocket costs and benefit designs that affect the affordability of coverage. They also reiterated the importance of having a federal floor of protections such as network adequacy requirements and essential health benefits to protect consumers.
These and other recommendations from stakeholders, including insurers and state officials, may be incorporated into imminent future rulemaking, such as the annual Notice of Benefit and Payment Parameters.