How Trump insurance changes could affect coverage next year

Andrew Cummings
April 16, 2017

The changes, which take effect later this year, include a shortened open enrollment period for PPACA plans.

The controversial proposal by the Department of Health and Human Services drew letters from almost 4,000 organizations and individuals during an unusually short, 20-day public comment period that ended in early March. Insurers were generally supportive.

That doesn't calm the nerves of health insurance company officials, however.

"Does it meet all the carriers' asks when it comes to what changes are needed?"

"The bottom line is that while the final rule addresses some of the challenges in the market, I think the reaction will be that it doesn't go far enough", said Cara Kelly, a vice president at the consulting firm Avalere Health.

"Health plans and the consumers they serve need to know that funding for cost-sharing reduction subsidies will continue uninterrupted", said Marilyn Tavenner, CEO of America's Health Insurance Plans, a main industry lobbying group. Some beneficiaries of CSR have filed a motion to intervene in the suit so that they can defend the payment structure in the event the Trump administration does not.


She could not be reached late Thursday for comment on the final version. Insurers are to start filing premium proposals for the ACA marketplaces in May in some states, and by June 21 for the federal exchanges.

Trump isn't fooling many people about his intentions.

Pennsylvania was typical. Until the ACA mandated that insurers treat sick and healthy people equally, buying insurance was the wild, wild West.

Numerous changes follow recommendations from insurers, who wanted the government to address shortcomings with HealthCare.gov markets, including complaints that some people are gaming the system by signing up only when they get sick and then dropping out after being treated. It's basically three groups of people.

Customers will have 45 days to shop for 2018 coverage, starting November 1 and ending December 15. The new regulations also make it more hard for people who have major life changes, such as getting married or moving jobs, to gain insurance after the enrollment period.

An open-enrollment window that is roughly half as long as the current window of 90 days.


After the Republican health care plan collapsed last month, beset by intra-party divisions and widespread public revulsion, Donald Trump immediately blamed Democrats.

Insurers are watching the situation with trepidation, with rapidly approaching deadlines for announcing whether they will continue selling plans on the insurance marketplaces next year. The proposed rule would only have required back payment to the same issuer.

Customers will now have to verify first that they qualify for a special-enrollment period before they can enroll.

According to Helen Schaub, New York state director of policy and legislation for 1199 SEIU, one amendment to the bill, sponsored by two New York Republicans, would affect New York alone by withholding federal funds from the state equal to the amount of Medicaid costs the state shifts to counties.

Fix the "family glitch": The so-called family glitch prevents family members of people with employer-sponsored health insurance from being eligible for premium assistance for individual coverage on the exchanges. With everything that's been going on with the health care law over the past few months, are the law's tax requirements still in force? Something new is happening in a health care debate dominated for seven years by the twists and turns of Barack Obamas signature law. Insurers are allowed wiggle room of plus or minus 2 percent around those averages. (It exempts certain silver plans for low-income consumers from the change.) So, for example, a bronze plan might cover only 56 percent of costs and silver 66 percent. It could also raise out-of-pocket medical expenses because it gives insurers more flexibility in determining the value of their coverage.

But that steep increase in his insurance rate was completely legal, says Pennsylvania insurance commissioner, Teresa Miller.


One big problem in boosting enrollment has been that many potential consumers - particularly younger, healthier ones - say premiums are too high. "Many plans will likely drop out of the market". While the health law sets a maximum cap per year on such payments, for many people those deductibles are already thousands of dollars annually.

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