Health advocates blast proposals aimed at stabilizing Obamacare

WASHINGTON — The Trump administration and new Health and Human Services Secretary Tom Price are under fire over new proposed rules introduced Wednesday to help stabilize the troubled individual insurance market.

Health-care advocates and congressional Democrats claim the proposals are a wish-list-come-true for the insurance industry and would weaken or reverse many important consumer protections of the Affordable Care Act.

The rules, which would take effect in coverage year 2018, would cut the marketplace enrollment period in half from three months to 45 days — Nov. 1, 2017 through Dec. 15, 2017 — for coverage beginning Jan. 1, 2018.

The proposal would also lower the minimum coverage requirements for policies to be designated at the gold, silver, bronze and platinum metal levels. For example, bronze plans that must now cover no less than 60 percent of medical costs would be allowed to cover 56 percent to 62 percent of medical costs. Silver plans covering at least 70 percent of costs, could cover 66 percent to 72 percent under the proposal.

“The provisions in this proposed rule aim to improve the health and stability of the Exchanges,” the 74-page proposal states. “They provide additional flexibility to issuers for plan designs, reduce regulatory burden, seek to improve the risk pool and lower premiums by reducing gaming and adverse selection and (incentivizing) consumers to maintain continuous coverage.”

Insurers were heartened by the moves to steady the Obamacare marketplaces, where insurers have faced higher-than-expected medical costs, lower enrollment and fewer young plan members to offset the cost of sicker, older plan members.

On Tuesday, Humana announced plans to halt marketplace coverage in 11 states next year as Congress decides how to repeal, repair or replace the troubled health law.

To address insurers’ concerns about people using the enrollment period to sign up for coverage only after they require medical care, the Trump administration plans to implement a pilot program to widen pre-enrollment screening from half to all applicants in the enrollment period beginning in June 2017 in all states that use the HealthCare.gov marketplace.

Special enrollment periods extend the enrollment opportunities for people who lose or must adjust their coverage due to job loss, relocation, childbirth or other qualifying events.

The administration expects 650,000 people to be subject to the enhanced screening, which it estimates will take 12 minutes apiece and cost more than $5.3 million to execute.

Consumers would be given 30 days to provide documentation under the Trump plan, during which time their coverage would be “pending” and would not apply. Currently people have up to 90 days to make a payment during which their coverage remains in effect.