Trump administration proposes stricter Obamacare rules

Info box: "If we dont take more steps like that, having an Obamacare subsidy will be like having a bus ticket in a town where no buses run, because there will be zero choices to buy," Senator Lamar Alexander, chairman of the Senate health

Brendan Mcdermid—X90143
FILE PHOTO: A trader points up at a display on the floor of the New York Stock Exchange.

NEW YORK — The Trump administration on Wednesday proposed changes to the Affordable Care Act (ACA) individual insurance market that insurers welcomed as a good start but that others pointed out could raise out-of-pocket cost for consumers.President Donald Trump and congressional Republicans have promised to scrap the 2010 health care law that is a key legacy of Democrat Barack Obama’s presidency. But they are struggling to agree on a replacement for the law, which extended health insurance to 20 million Americans.The proposed new rule, issued by a division of the U.S. Department of Health and Human Services, sets out changes that are meant to shore up the system developed by Obama. It is unclear which elements of this system could survive in the Republicans’ replacement.The rule does not address changes that must be made by law, such as for the Affordable Care Act’s income-based subsidies.The changes would tighten enrollment processes and allow insurers to collect unpaid premium payments, making it tougher for people to move in and out of insurance plans. Insurers say “gaming the system” has created an unprofitable mix of healthy and sick customers.Separately, the administration backed off implementing tougher oversight of the individual mandate, the requirement for all Americans to have health insurance or pay a fine, that was due to go into effect for 2016 taxes.The Internal Revenue Service said as a result of Trump’s executive order to reduce regulatory burden, it will not reject tax filings for the year 2016 that fail to indicate whether they had health coverage or paid the penalty set under the ACA, often called Obamacare. This is a return to the policy for 2015 taxes, the IRS said.The mandate was supposed to bring in healthy customers but Republicans have vowed to overturn it and insurers say it has not worked.Aetna CEO Mark Bertolini on Wednesday said during a Wall Street Journal forum that the Obamacare exchanges had entered a “death spiral” in which rising premiums pushed out the healthiest customers, which in turn raises rates.Aetna cut back offering new plans for 2017 and it and Anthem have said that without changes, they might not take part after this year. Humana on Tuesday said it was pulling out of this market altogether for 2018.Bertolini said in a statement that new Health Secretary Tom Price and the Trump administration have “taken some good initial steps with the proposed regulation.” The top two industry groups, America’s Health Insurance Plans and Blue Cross Blue Shield Association, echoed that view.The Centers for Medicare & Medicaid Services, which are part of the Department of Health and Human Services, on Wednesday proposed the new rule that includes verifying the status of enrollees outside of the usual enrollment period.It also proposes insurers can collect unpaid premiums from members when they sign up with the same issuer again, an incentive for people to always have insurance.In addition, it proposed lowering the amount of guaranteed coverage for some “silver” level plans in the program, which it said could raise out-of-pocket spending and cut premiums.It would give the states oversight of doctor and hospital networks included in the plans, reflecting a Republican theme that health care oversight be reduced at the federal level.The rule proposes shortening the open enrollment period for the individual market to Nov. 1 through Dec. 15, similar to employer-sponsored insurance market and Medicare.Patient advocate Families USA said the new rules would discourage younger, healthier people from enrolling, reduce financial assistance for families and make it harder for them to find networks that include their doctors.Republican lawmakers, who are working on an ACA replacement, said the rule was a start.”If we don’t take more steps like that, having an Obamacare subsidy will be like having a bus ticket in a town where no buses run, because there will be zero choices to buy,” Sen. Lamar Alexander (R-Tenn.), chairman of the Senate health committee, told reporters outside the Senate.Anthem said on Wednesday this week it filed a lawsuit to block smaller rival Cigna from officially terminating their proposed $54 billion merger, a transaction already rejected by U.S. antitrust regulators.The deal would have created the largest U.S. health insurer. Rivals Aetna and Humana had sought their own merger, representing an unprecedented consolidation among U.S. health insurers.In separate rulings, federal judges struck down both deals as anticompetitive, at the request of the Justice Department. Aetna and Humana said on Tuesday they were ending their deal, but Anthem filed an appeal of its ruling.Cigna, however, said on Tuesday it notified Anthem it had ended the deal and that Anthem was required to pay a $1.85 billion break-up fee under their agreement.