Trump Administration Issues Rule on Stricter PPACA Enrollment

Changes aim to help insurers remain in marketplaces

The Trump administration has issued a final rule that will shorten the Patient Protection and Affordable Care Act (PPACA) enrollment period and give insurers more of what they say they need in the individual insurance market, according to a Reuters report. The new initiative will make it harder for some consumers to purchase insurance, health care experts said. It could also raise out-of-pocket medical expenses because it gives insurers more flexibility in determining the value of their coverage.

Issued by a division of the Department of Health and Human Services and first proposed in February, the rule aims to help insurers, who have lost hundreds of millions of dollars in the individual insurance markets set up by the PPACA. Several major insurers, including Humana and Aetna, have announced plans to exit some state exchanges in 2018.

The changes, which take effect later this year, include a shortened open enrollment period for PPACA plans. They also make it harder for people to enroll outside that period, which is allowed under certain circumstances, such as a pregnancy or a move.

The rule could also allow insurers to collect unpaid premium payments and make it harder for people to move in and out of insurance plans, according to health care industry experts.

Moreover, the rule gives states broader authority by removing the federal government's role in overseeing doctor and hospital networks included in insurance plans. Republicans have said any health care reform or overhaul must give states more flexibility.

Recently, Trump said in an interview that he may withhold PPACA subsidy payments to insurers that amount to approximately $7 billion a year to force Democrats back to the negotiating table.

Marilyn Tavenner, president and chief executive of America’s Health Insurance Plans, responded in a statement that funding for the payments must continue uninterrupted. Otherwise, she said, premiums will rise 20% across the market, and more insurers would drop out of the exchanges.

Source: Reuters; April 13, 2017.