AHIP Warns Proposed ACA Exchange Rule Could Threaten Market’s Growing Stability

AHIP, the top lobbying organization for commercial insurers, is warning the feds that provisions in its proposed rule governing the Affordable Care Act’s exchanges for 2023 could “undermine” the growing stability there.

For instance, the group says in comments (PDF) submitted late Thursday that potential changes to requirements for essential health benefits would limit the ability for insurers to manage costs, particularly for prescription drugs, and manage chronic illnesses.

In addition, AHIP said that a proposed requirement for insurers to offer standardized plan options on the exchanges would “stifle innovation” and includes provisions that would be hard for payers to roll out, such as common drug formulary designs.

Instead, AHIP suggests that the Centers for Medicare & Medicaid Services deploy an approach in which payers are required to offer one standardized silver plan option for 2023, and then gather enrollment data to see if the plan designs are meeting consumer needs.

“The continued stability and growth of the ACA marketplaces is also due in large part to policies that have promoted a stable regulatory environment, increased competition, and enabled issuers to offer innovative products that consumers want and need,” AHIP said. “However, we are concerned that some of the policies proposed in this Payment Notice may take large steps backward, undermining this hard-won stability and significantly limiting innovation and competition.”

CMS said earlier Thursday that the final tally for ACA open enrollment was 14.5 million, a record. The market had been improving for some time, luring big-name insurers such as UnitedHealthcare and Aetna back in, but the Biden administration’s temporary expansion of premium tax credits has led enrollment to skyrocket.

In the rule, CMS also proposes mandating network adequacy reviews for plans offered on the federal exchange, Healthcare.gov.

AHIP said proposed network adequacy standards could make it harder for payers to design innovative plans, lead to higher premiums and place an undue burden on both payers and providers.

“If finalized, we recommend network adequacy standards be deferred to plan year 2024 to provide time to address these outstanding issues and allow issuers the time to change to their networks,” the group said.

The organization is urging CMS to extend the comment window on the rule to allow additional time for feedback on its proposals.


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