Health Care

Trump administration changes ACA rules, but insurers say more fixes needed

The Trump administration announced a few changes to the Affordable Care Act to try to address insurers’ complaints about the markets.
The Trump administration announced a few changes to the Affordable Care Act to try to address insurers’ complaints about the markets. The Associated Press

With the “repeal and replace” effort at an impasse on Capitol Hill, the Trump administration has released a set of fixes to stabilize the Affordable Care Act’s shaky insurance markets for next year.

The insurance industry quickly said the changes, released Thursday evening, don’t go far enough.

While calling the administration action a step in the right direction, the industry is looking for a guarantee that the government will also keep paying billions in “cost-sharing” subsidies that help consumers with high deductibles. President Donald Trump says he hasn’t made up his mind on that.

Kelly Cannon, a spokeswoman for Blue Cross and Blue Shield of Kansas City, released a statement saying the company applauded the changes, but noted that the federal administrator who spearheaded them, Seema Verma, said herself that they “are not a long-term cure” for problems in the Affordable Care Act insurance markets.

“We will continue our work with legislators and regulators to address our concerns and find solutions to help further stabilize these markets,” Cannon said.

Medica spokesman Greg Bury offered a slightly more optimistic statement from the Minnesota-based insurer that sells plans on the Affordable Care Act exchange in Kansas.

“The new regulation helps us understand the rules of the road for next year and gives us time to incorporate these changes into our strategy for 2018,” Bury said via email. “We appreciate some of the flexibility the regulation gives us, but we know more needs to be done through federal legislation to help stabilize the individual market.”

The other insurer on the Affordable Care Act exchange in Missouri, Cigna, did not respond to a request for comment.

National groups that represent health insurers were also unsatisfied.

“There is still too much instability and uncertainty in this market,” Marilyn Tavenner, president of America’s Health Insurance Plans and the industry’s top lobbyist, said in a statement. “Health plans and the consumers they serve need to know that funding for cost-sharing reduction subsidies will continue uninterrupted.”

Republicans contend that the Affordable Care Act is beyond repair, but their “repeal and replace” slogan hasn’t been easy to put into practice, or politically popular. So the administration is trying to keep the existing system going temporarily as it pursues a total remake.

Many of the changes follow recommendations from insurers, who wanted the government to address shortcomings with 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.

The changes include:

▪ A shortened sign-up window of 45 days, starting with coverage for 2018. That’s about half as long as the current open enrollment season.

▪ Curbs on “special enrollment periods” that allow consumers to sign up outside the normal open enrollment window. Insurers say these have been too easily granted, allowing some people to sign up only when they need costly treatment.

▪ Allowing an insurer to collect past debt for unpaid premiums from the prior 12 months before applying a consumer’s payments to a new policy.

▪ Giving insurers more flexibility to design low-premium plans that can be tailored to young adults.

“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.

The changes come as insurers are figuring out their plans for 2018.

Consumers likely won’t know for certain what sort of choices they will have until late summer or early fall, a couple months before open enrollment begins.

This year saw premium increases averaging 25 percent for a standard plan in states served by Some insurers say they’ve lost hundreds of millions of dollars, and many have pulled back or are considering it.

Most communities will have competing insurers on the public marketplace next year, but a growing number will be down to one, and some areas may face having none.

Humana has already announced it is dropping all of its Affordable Care Act plans in 2018, which would leave Blue KC and Cigna as the only options on the Missouri side of the Kansas City metro area, unless new ones join.

On the Kansas side, Medica has capped its enrollment at 10,000 people statewide, which is less than 10 percent of all Kansans enrolled in the Affordable Care Act. That leaves the majority reliant on Blue KC, which handles Johnson County and Wyandotte County, and Blue Cross and Blue Shield of Kansas, which handles the rest of the state.

Blue KC has improved its rate-setting steadily since the beginning of the Affordable Care Act three years ago, and in 2016 for the first time the organization made more in premiums than it spent on medical claims on the exchange plans. Blue Cross of Kansas has not been able to reach that milestone and this year began offering on the exchange only HMO plans that provide no compensation for out-of-network care.

The Associated Press contributed.

Andy Marso: 816-234-4055, @andymarso