Con­sumers can skip Health­ for 2018 in­sur­ance cov­er­age

Modern Healthcare - - NEWS - By Vir­gil Dickson

The Trump ad­min­is­tra­tion took steps last week that could make it eas­ier for con­sumers to get cov­er­age un­der the Af­ford­able Care Act, al­beit at the po­ten­tial demise of the fed­eral in­sur­ance ex­change.

The CMS said it would al­low peo­ple to by­pass Health­ in order to buy an ACA-ap­proved plan for 2018. In­di­vid­u­als will be able to get cov­er­age di­rectly from a bro­ker or an in­surer’s web­site in­stead of hav­ing to go through the fed­eral mar­ket­place, the CMS an­nounced. That news came just two days af­ter small busi­nesses were given per­mis­sion to skip the fed­eral mar­ket­place as well.

Cur­rently, con­sumers work­ing with a bro­ker must go to Health­ to de­ter­mine el­i­gi­bil­ity for sub­si­dies or tax cred­its. Even­tu­ally, the ap­pli­cant goes back to the bro­ker’s or in­surer’s web­site to fi­nal­ize their cov­er­age.

When open en­roll­ment kicks off Nov. 1, ap­pli­cants will be able to com­plete the en­tire process, in­clud­ing check­ing on el­i­gi­bil­ity for sub­si­dies and tax cred­its, on a bro­ker or in­sur­ance com­pany web­site.

Bro­kers his­tor­i­cally sign up at least 50% of ex­change en­rollees.

The other pol­icy an­nounced last week al­lows com­pa­nies with 50 or fewer em­ploy­ees to also work di­rectly with bro­kers to of­fer cov­er­age to work­ers. Small busi­nesses will still have to use the Small Busi­ness Health Op­tions Pro­gram mar­ket­place, known as SHOP, to de­ter­mine el­i­gi­bil­ity, how­ever. There’s some spec­u­la­tion that the move is an at­tempt to re­duce fed­eral over­sight of SHOP given the low en­roll­ment num­bers. As of Jan­uary 2017, just 230,000 peo­ple have used the pro­gram.

De­pend­ing on how the pol­icy for in­di­vid­u­als is re­ceived, the Trump ad­min­is­tra­tion may seek other ways to ex­empt peo­ple from us­ing the fed­eral mar­ket­place. “If this works very well, there will be pro­pos­als to shrink or elim­i­nate Health­,” pre­dicted Mark Pauly, a health econ­o­mist at the Whar­ton School of the Univer­sity of Penn­syl­va­nia.

The Trump ad­min­is­tra­tion says the goal is to help cre­ate sta­bil­ity in the health in­sur­ance mar­ket. “It is com­mon sense to make it as sim­ple and easy as pos­si­ble for con­sumers to shop for and ac­cess health cov­er­age,” CMS Ad­min­is­tra­tor Seema Ver- ma said in a state­ment. “It is time to get the fed­eral gov­ern­ment out of the way and give pa­tients the best tools to make their own health­care de­ci­sions.”

Broad­en­ing dis­tri­bu­tion chan­nels for con­sumers to gain cov­er­age makes sense, said Kevin Couni­han, CEO of Health­ un­der Pres­i­dent Barack Obama. He cau­tioned that the CMS should cer­tify that third-party ven­dors have the nec­es­sary ad­min­is­tra­tive ca­pa­bil­i­ties.

The Obama ad­min­is­tra­tion had raised the idea for a di­rect en­roll­ment in pro­posed rule­mak­ing, but it was never fi­nal­ized. Se­ri­ous con­cerns had been raised about con­sumers hav­ing to pro­vide per­sonal fi­nan­cial in­for­ma­tion to third par­ties, which cre­ates more op­por­tu­ni­ties for that in­for­ma­tion to be vul­ner­a­ble,, said Larry Le­vitt, a se­nior vice pres­i­dent at the Kaiser Fam­ily Foun­da­tion.

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