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The next enrollment period for the Affordable Care Act doesn’t open for more than six months.
However, there are some quiet changes that’ve been made to the rules governing Obamacare that will affect what kind of health insurance consumers can buy and how much they’ll pay for it.
Last week, the Centers for Medicare and Medicaid Services (CMS) released new rules that will affect 2019 Affordable Care Act (ACA) enrollment.
Several regulations take effect next year.
They include allowing states to give insurance companies permission to sell cheaper, short-term plans that are exempt from the basic coverage requirements under Obamacare.
The CMS also revealed new “hardship exemptions” that took effect immediately.
They include allowing people to opt out of coverage if their county has only one insurer in its ACA exchange marketplace.
In addition, opponents of abortion are exempt from enrollment requirements if all the insurers in their marketplace provide coverage for abortion services.
White House officials didn’t respond to requests from Healthline for an interview.
They’ve publicly said the changes were done in response to rising healthcare costs.
“Too many Americans are facing skyrocketing premiums that they can’t afford and every year consumers are faced with the threat of fewer choices. This rule gives states new tools to stabilize their health insurance markets and empower citizens to find coverage that fits their families’ needs and budgets,” said CMS Administrator Seema Verma in a statement.
However, critics of the changes say the new regulations will destabilize the ACA insurance markets, raise premiums, and limit the healthcare services consumers receive.
Here’s a look at some of the new rules and reaction to them.
Short-term, low-cost plans
The new rules will give states the option to extend the current 90-day limit on short-term, basic coverage plans to 12 months.
These plans provide bare-bones insurance coverage for a low price.
Experts say younger, healthier consumers will be attracted to these plans because they’re less expensive, and these consumers usually don’t need many healthcare services.
It might sound good on paper, but Democrats are already railing against it.
Late last week, Democratic congressional leaders wrote a letter to White House officials, saying the rule will “encourage the sale of junk health plans that will undermine consumer protections.”
They note these plans often don’t cover preexisting conditions or services such as mental health and maternity care.
They add the plans will prompt younger consumers to leave ACA marketplace plans, leaving those insurers with less healthy, more expensive customers.
Experts interviewed by Healthline said those concerns are justified.
Dan Mendelson, CEO of Avalere Health consultants, said these cheaper plans will dilute the exchange pools by attracting healthy consumers.
“It’s making it easier for individuals to say no to the exchanges,” he told Healthline.
He said rising premiums will drive these folks to the cheap plans.
“We’ll see people sign up because that’s what they want,” Mendelson said.
Kurt Mosley, the vice president of strategic alliances at Merritt Hawkins health consultants, sees another problem.
He said consumers who buy these so-called “junk insurance” plans may get caught by surprise.
They’ll either seek services or be sent to an “out-of-network” medical professional and then discover their cheap insurance plan doesn’t cover it.
Greg Gierer, senior vice president of policy at America’s Health Insurance Plans (AHIP), agrees.
“These plans are not really a substitute for comprehensive insurance coverage,” he told Healthline.
“It’s going to leave individuals vulnerable,” added Dr. Michael Munger, president of the American Academy of Family Physicians. “They’ll run the risk of medical bankruptcy.”
Another problem the experts see is consumers with cheaper insurance plans may skip preventive treatment services, such as colonoscopies, blood tests or EKGs, because they aren’t covered.
“Patients may skimp on medical services they need,” Munger told Healthline. “They’ll be gambling with their health.”
The situation will be further complicated when the individual mandate requirement goes away next year.
The mandate repeal was part of the Republican tax reform bill that was approved in December.
Under the new provision, consumers will no longer face a fine if they don’t purchase health insurance.
The experts say this will further dilute the exchange pools when younger, healthy individuals opt out of coverage.
“It’ll create an unbalanced risk pool,” said Cathryn Donaldson, director of communications for AHIP.
“It will destabilize the markets,” added Dr. Krishnan Narasimhan, a board member for Doctors for America.
Another rule that’s changing next year is the so-called “80/20” rule.
Under this Obamacare regulation, insurance companies are required to spend 80 percent of the money they take in from premiums on healthcare costs and quality improvement activities. The other 20 percent can go to administrative, overhead, and marketing costs.
Mendelson thinks there may be an upside to this change.
“It’s allowing insurance companies to have some flexibility in their products,” he said.
Mosley added that the change probably won’t have that much of an impact.
Others aren’t so sure.
“This could have a huge effect,” Narasimhan told Healthline. “The less they spend on individual services, the better off [the insurance companies] are.”
The ‘hardship’ exemptions
Other changes have already taken effect.
Most involve so-called “hardship exemptions” to enrollment requirements.
One new rule allows consumers to opt out of coverage if there’s only one insurer participating in their exchange market.
Gierer said this change affects about half the ACA markets and about 26 percent of people eligible to sign up.
Mendelson said the change seems like a “rational” option and probably won’t have much impact.
Narasimhan also said the one-county exemption was a “proper option” to consider.
Again, others don’t see it that way.
“We have concerns about the expanded hardship exemptions,” said Gierer. “It could have far-reaching effects. It’s not something that’s helpful.”
“It’s just going to give people another excuse to get out of the marketplace,” he said. “The whole idea here is to get people insured.”
The experts see the one-county exemption driving away customers from a single insurer and then forcing that company to leave the marketplace.
“You could have some counties that are bare,” said Munger.
Perhaps the most controversial exemption is the one involving abortion services.
The new rules allow opponents of abortion to opt out of coverage if all the insurers in their marketplace help pay for abortion services.
Some experts point out that the change may not affect that many markets since a number of insurance companies already don’t provide abortion service coverage.
In addition, some states already prohibit ACA plans from covering abortion procedures.
“I’m not sure if it’s filling a need that isn’t already being met,” said Narasimhan.
The experts say the rule change seems more designed to meet a campaign promise President Trump made to abortion opponents.
“It appears to be an action to deliver to the base a promise made during the campaign,” said Mendelson.
Eric Scheidler, the executive director of the Pro-Life Action League, agrees the rule change was probably done for political purposes.
But he thinks it was the right decision.
“It’s a welcome change for a lot of people,” Scheidler told Healthline. “People don’t want to be contributing to a pool that’s covering abortion.”
Some critics have said this new rule could set a precedent for other single-issue groups, such as those who oppose vaccinations, to seek out their own exemptions.
Scheidler said there’s a difference.
He said vaccine opponents don’t necessarily want everyone to skip inoculations. They just don’t want to submit to them themselves.
However, abortion opponents don’t want that service provided to anyone.
“I don’t think it’s the same sort of case,” he said. “I’m not at all troubled by it. I don’t see a slippery slope.”
Others see problems with letting people skip health insurance because of their personal beliefs.
Munger notes that as a man, he doesn’t need maternity services, but he should still have to pay for that healthcare for the good of the overall community.
Otherwise, he said, you end up with “Swiss cheese” health coverage.
“We need to be there to help pay for services as a whole,” he said.
Narasimhan also sees a troubling trend here.
“If you let everybody opt out for personal reasons, the system is going to collapse,” he said.