CMS Final Rule Would Increase Costs for Moderate-Income Families and Reduce Open Enrollment

RulesFollow up from blog posted February 21, 2017

Yesterday afternoon, the Centers for Medicare and Medicaid Services (CMS) issued a final rule claiming to stabilize the Affordable Care Act insurance markets. In fact, it does just the opposite.

HCFANY and thousands of other consumer and provider groups submitted comments in opposition to the proposed version of the rule because many of its provisions would have harmed consumers. However, the rule was finalized largely as proposed.

The final rule reduces the open enrollment period for individual and small group health insurance plans from 13 weeks to just six weeks, which gives consumers significantly less time to shop around for and enroll in the best plan for them.

The final rule also decreases the allowable actuarial values for health plans at each metal level, which could reduce the advanced premium tax credits (APTCs) that help make health plans purchased through the Marketplace more affordable for moderate-income individuals and families. According to an analysis from the Center on Budget and Policy Priorities, even a 2 percent decrease in actuarial value could result in a $327 reduction in APTCs for an individual.

The final rule will make it more difficult for consumers to qualify for and enroll in health coverage through special enrollment periods, which could lead to gaps in coverage and deter enrollment.

Currently, it is unclear how this rule will affect New York because state officials are still studying it closely. Come back to HCFANY next week for more information.

RulesLast week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for 2018. According to the press release, the proposed rule includes “reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients.”

However, many of the policy changes in the proposed rule would harm consumers. For example, a recent analysis from the non-partisan Center on Budget and Policy Priorities explains that the proposed rule would reduce the advanced premium tax credits that help make plans purchased through the Marketplace more affordable for moderate-income individuals in families.

According to the analysis, the proposed rule would result in lower tax credits because it lowers the actuarial value standards for “silver” level plans. This means that premiums and the percentage of costs covered by the insurer would decrease, but deductibles and copayments for consumers would increase. Under the Affordable Care Act, tax credits for consumers purchasing coverage through the Marketplace are calculated based on the second lowest cost silver plan. By allowing for lower value silver plans, the new rule would force consumers to pay more out of pocket to maintain their current level of coverage.

Furthermore, the CMS proposed rule also includes provisions to require consumers to provide supporting documentation for special enrollment periods before they can enroll in coverage. The proposed rule would also permit insurance companies to collect any missed premium payments before allowing consumers to re-enroll. Both of these changes could lead to gaps in coverage for consumers or deter enrollment.

Finally, the proposed rule would reduce the open enrollment period for individual and small group health insurance plans from 13 weeks to 6 weeks, which would give consumer significantly less time shop around for and enroll in the best plan for them.

HeartsMembers of Congress are debating a repeal of the Affordable Care Act (ACA) and major cuts to Medicaid, Medicare, and other health coverage programs. We know consumers are looking for ways to get involved in the fight for health care.

This Valentine’s Day, HCFANY and partners are launching a Valentine’s Day campaign. Here are the different ways you can participate:

  • Use one of the sample Valentines or make your own and mail them to the district offices of your representative in Congress
  • Use one of the sample Twitter “tiles” and tweet a message to your elected officials on Valentine’s Day asking them to have a heart and save our health care. A list of Twitter handles for New York members of Congress can be found here.
  • If your representative in Congress is already supportive of the ACA, this is a great opportunity to say thank you!

Sample messages and hash tags:

  • This Valentine’s Day, have a heart. Save our health care.
  • Thank you for showing the ACA some love. Happy Valentine’s Day.
  • #SaveOurHealthCare
  • #ProtectOurCare
  • #IfILoseCoverage

 

WowLast week, the NY State of Health (NYSOH), New York’s official health plan Marketplace, announced that more than 3.6 million New Yorkers have enrolled in health coverage through NYSOH. This represents an increase of 28 percent since January 2016. More than 45,000 New Yorkers enrolled in the final two days of the 2017 open enrollment period.

According to the press release, more than 242,000 people enrolled in Qualified Health Plans, and nearly 60 percent qualified for federal subsidies to make monthly premiums more affordable.

The release also highlights the major success of the Essential Plan, New York’s Basic Health Plan, which now has more than 665,000 New Yorkers enrolled – a 75 percent increase since last year.

There are also more than 2.4 million New Yorkers enrolled in Medicaid through the Marketplace and nearly 300,000 enrolled in Child Health Plus.

Open enrollment has ended, but New Yorkers eligible for Medicaid, Child Health Plus, or Essential Plan coverage can enroll at any time through the NYSOH website. If you need help enrolling, Navigators are available to provide in-person assistance. Please visit https://info.nystateofhealth.ny.gov/IPANavigatorSiteLocations or call (888) 614-5400 to find a Navigator in your area.