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November 25, 2020

Patient Advocates Demand Program Integrity for Marketplace Purchases in Defiance of Proposed Rule

A last minute maneuver by the Trump Administration could eliminate healthcare.gov and increase bureaucratic barriers for those wishing to purchase individual plans, according the National Patient Advocate Foundation, a national non-profit organization devoted to advancing access to affordable, equitable and quality health care.

 

In a proposed rule released shortly before the Thanksgiving holiday, the Trump Administration would allow states to require people to purchase insurance directly from insurers or private brokers in lieu of healthcare.gov. With only a 30 day comment period, the proposed rule would eliminate transparency for patients and allow private brokers to display plans that do not include all the mandated patient protections afforded by the Affordable Care Act alongside compliant plans.

 

“Patients worry about conflicts of interest if they purchase away from healthcare.gov,” said Rebecca Kirch, executive vice president of policy and programs. “People want the option of purchasing from a neutral platform where they can be assured that the seller isn’t financially incentivized to push them into the wrong plan.”

 

Healthcare.gov doesn’t only function as a marketplace for health insurance plans. The website also screens applicants for Medicaid eligibility and will forward those who potentially qualify to the appropriate state agencies. “Without this crucial infrastructure,” said Kirch, “thousands of qualifying patients and children may lose out on coverage.”

 

Earlier this month, CMS approved a Section 1332 waiver request from Georgia that will transition the state’s individual market from healthcare.gov to a private sector platform where people will shop for insurance through brokers, agents and individual health insurance companies.

 

The proposed rule also requires state-run marketplaces to verify at least 75% of new enrollments for people who purchase plans during a special enrollment period. “Tightening those standards on [special enrollment period] eligibility verification is expected to protect the risk pool and, in turn, lower premiums by preventing people from waiting until they are sick to enroll,” said CMS in a press release announcing the proposed rule.

 

“When the Administration talks about ‘protecting the risk pool,’” said Kirch, “we worry they just mean stopping people who need coverage from enrolling. If we aspire to improve the individual experience, improve population health and reduce costs, these proposed rules fail on all counts.”

 

The full proposed rule can be found here.