Health Insurers, Advocates Clash Over Proposed Obamacare Updates


August 6, 2021 9:09 pm

Insurers and consumer advocates are facing off over a Department of Health and Human Services proposal to extend the Affordable Care Act’s annual enrollment period and allow year-round sign-ups for those with low incomes.

In public comment letters on the proposed update (RIN 0938–AU60) of Obamacare benefits and payment parameters, major marketplace insurers like AnthemCentene Corp., and UnitedHealthcare, all opposed a plan to lengthen the federal open enrollment period from 45 days to 75 days.

The longer enrollment would allow people who “were automatically re-enrolled into a plan to reevaluate their options after receiving updated plan cost information in the new year and select a new plan that is more affordable,” Fred Riccardi, president of the Medicare Rights Center, said in a comment letter.

But insurer Molina Healthcare said the proposal “creates the potential of adverse selection as healthier members could defer enrollment until the last minute and unhealthier members would enroll earlier, which would increase costs and premiums,” Carolyn Ingram, Molina’s executive vice president for external affairs, said.

If finalized by the Centers for Medicare & Medicaid Services, the annual sign-up period would run from Nov. 1 to Jan. 15. It now ends Dec. 15.

Instead of a longer enrollment period, America’s Health Insurance Plans recommends that the CMS establish a targeted special enrollment period for those “who automatically reenroll and experience an increase in premium. The end of the open enrollment period, December 15, should be the triggering event for a 30-day special enrollment period with prospective effective dates,” AHIP’s comment letter said.

Special Enrollment

The industry also opposes a CMS plan for a new monthly special enrollment period for adults and dependents who are eligible for advance premium tax credits—and whose household income is less than 150% of the federal poverty level. It would allow them to enroll in marketplace coverage whenever their income or eligibility permits. They now must experience a qualifying life event or wait for the annual open enrollment period to get coverage.

Riccardi and Pennsylvania Insurance Commissioner Jessica Altman both support the CMS’s special enrollment proposal. It’s designed to help people who lose Medicaid coverage, a population that’s sure to increase when the pandemic health emergency is lifted.

The special sign-up period would allow “Pennsylvanians to ensure that those losing Medicaid coverage have access to quality, affordable health coverage and care throughout the marketplace,” Altman wrote in her comment letter.

AHIP says that can be done through enhanced noticing and special outreach that encourages people to maintain continuous coverage.

If people could enroll at any time, or change plan selections each month, “we anticipate consumers would enroll in coverage at the point of care and or change plans mid-year. Constant enrollments and disenrollments would undermine stability of the individual market and could result in higher premiums, narrower networks, and limit consumer choice,” Jeanette Thornton, AHIP’s senior vice president for product, employer, and commercial policy, said in her letter.

Standardized Plans

Anthem, which covers nearly 700,000 people in the individual market, said in its comment letter that the current 45-day enrollment period should continue. But if the CMS does make changes, it would prefer a longer annual enrollment period over the proposed special enrollment period.

If the CMS does extend the enrollment period, Anthem recommends that applications submitted by Dec. 15 have a Jan. 1 effective date. And those submitted between Dec. 16 and Jan. 15 take effect Feb. 1. As written, the current proposal doesn’t provide effective dates.

Insurers also don’t want the CMS to require them to offer standardized plan options thatare designed to make it easier for consumers to compare and shop for coverage. The CMS plans to resume standardized plan options in 2023 after a federal court overturned a Trump administration rule that scrapped the practice of designating some plans as “standardized options.” The agency will also propose standardized plan designs for 2023.

UnitedHealthCare recommended that CMS permit, rather than require standardized plan options to give issuers “the latitude to continue pursuing innovative offerings.”

Roughly 40 organizations representing patients with complex conditions like autoimmune diseases, HIV, and hepatitis, want the CMS to require federal marketplace insurers to offer some standardized plans that either cap cost-sharing for prescription drugs and require no co-pay or deductible. In a joint comment letter, the groups say the federal government should follow states like California, Delaware, Louisiana, and Maryland, as well as the District of Columbia “that cap the amount a patient must pay out-of-pocket for a one-month supply of a single prescription medication.”

AHIP says insurers shouldn’t be required to offer the plans and that the CMS should not “implement differential display of standardized plan options on” nor “give special preference to these plans.”

“We are concerned that a differential display would increase consumer confusion and may appear to favor some plans over others and inadvertently steer consumers or otherwise influence the shopping experience,” AHIP’s comment letter said.

To contact the reporter on this story: Tony Pugh in Washington at