House Republicans Offer Bills To Stabilize The Individual Insurance Market

January 31, 2017

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Source: Modern Healthcare

WASHINGTON — House Republicans have filed four separate bills intended to stabilize the individual insurance market while they pursue their strategy of repealing and replacing the Affordable Care Act.

The bills, to be discussed at an Energy and Commerce Committee hearing Thursday, address issues that insurers say have increased their costs and unbalanced the risk pool, thus driving up premiums and making the individual market a less viable business for them. But consumer advocates caution that these measures could make coverage and care less accessible and affordable for lower-income, older, and sicker people.

The multiple bills reflect the announced approach of GOP leaders to replace Obamacare through a number of separate measures rather than one large bill. Some of these individual pieces could conceivably attract enough Democratic support to pass.

The bills may reflect a calculation by Republicans that they won’t be able to pass the market-stabilization mechanisms sought by insurers as part of expedited legislation to repeal the ACA, which could pass on a straight party-line vote. So they may have decided they need to attract at least eight Democratic votes in the Senate to avoid a Democratic filibuster. The bills also may signal that Republicans increasingly realize that repeal won’t come as fast as they hoped.

One GOP bill would give insurers greater leeway than currently allowed under the ACA to charge older members more than younger members. It would increase the so-called age band, letting insurers charge older members five times more than younger people, rather than the current limit of three times more.

Insurers argue this would enable them to attract more younger, healthier members to offset the high costs of older, sicker enrollees, and more accurately reflect the higher costs associated with older members. But some experts predict it would make coverage unaffordable for older people and force some to drop coverage, while doing little to make premiums more affordable for younger people. Many younger people, they say, either receive substantial premium subsidies, are covered under their parents’ plan, or qualify for expanded Medicaid.

A second bill would make it harder for people to sign up for individual coverage during so-called special enrollment periods based on changes in life circumstances. Insurers say some people have been signing up outside the annual open enrollment period when they realize they need medical services, then dropping the coverage after receiving the care.

The bill would require HHS to more rigorously verify that people meet the requirements for special enrollment, including job loss or divorce. The Obama administration already had tightened verification requirements, but insurers felt they weren’t sufficient and wanted to be able to handle this process themselves.

A third bill would crack down on what insurers’ say is some enrollees’ abuse of the ACA’s 90-day grace period provision. Plans say some people pay the initial months’ premiums, then get medical services and stop paying premiums. Under current law, insurers can only terminate coverage after 90 days of non-payment, which they say leaves them and healthcare providers on the hook. The bill would let states define the length of the grace period or reduce it to one month.

The fourth bill offers a general statement of policy rather than making specific changes. It says that whatever Congress ultimately does in repealing and replacing the ACA, it will not allow a return to the pre-ACA situation of having Americans face coverage denials based on health status.

But unlike the ACA, this legislation would only apply guaranteed issue to people who have maintained continuous coverage. And it would allow insurers to base premiums on health status, meaning that premiums could be unaffordable for people with serious medical conditions.

There are other key market-stabilization issues that are not addressed by these bills. Insurers say it’s essential that congressional Republicans appropriate funds to pay insurers for the ACA’s required cost-sharing reductions for low-income enrollees. House Republicans have sued to block those payments. If the Trump administration drops the Obama administration’s pending appeal in the case, those payments will be cut off and many insurers warn they will exit the individual market.

In addition, health plans say Congress needs to restore risk-protection payments to compensate plans that sign up a disproportionate share of sicker people. But many Republicans have denounced such payments are corporate “bailouts.”

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