April 19, 2017

Market Stabilization Rule: Assessing the Trump Administration's First ACA Market-Related Regulation

On April 13, 2017, the Centers for Medicare and Medicaid Services (CMS) finalized its Marketplace Stabilization Rule. This is the first Trump administration regulation that applies to the health insurance markets remade by the Affordable Care Act (ACA). The unusual title of the regulation underscores the White House’s commitment to stabilizing the Obamacare health insurance exchanges. These marketplaces, which have roughly 12 million enrollees, experienced high premium increases (a national average of 25 percent) and diminished insurer participation (one third of U.S. counties have only one participating insurer) in 2017. The regulation follows previous modest policy changes designed to stabilize the markets by cutting down on the quantity of special enrollment periods and reduce “gaming” opportunities by exchange plan enrollees. The regulation is accompanied by new subregulatory guidance as well, which, most notably, lessens the federal role in certifying that exchange health plans meet ACA requirements, and deferring to state reviews in several cases.

The health policy specialists at Faegre Baker Daniels Consulting have created a chart summarizing the draft and final regulation and providing analysis of the impact of the final regulation’s provisions.

The Market Stabilization Regulation — Summary and Analysis chart addresses the following provisions:

  • Re-enrolling members with unpaid premiums from prior year (guaranteed availability)
  • Open Enrollment Period
  • Practices that incent continuous coverage
  • Actuarial value de minimus variation
  • Special enrollment periods (SEPs) — prospective verification
  • SEP changes to tighten program requirements
  • Network adequacy
  • Essential community providers
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