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Obama proposes some major ACA repair

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The Obama administration is planning rules changes to  try to fix some of the problems bedeviling the Affordable Care Act, especially  the flight of insurers from the exchanges set up under the ACA.

A central aim is to rebalancing the risk pool to reduce “adverse selection” of the sickest and costliest patients on the exchanges. Among the proposed changes, as summarized by FierceHealthcare:

  • Toughening proof of eligibility for Special Enrollment Period enrollees.

  • Encouraging consumers turning 65 to shift from ACA products to Medicare ones,  thus reducing the risk profile of a demographic with higher-than-average healthcare-use rates.

  • Boosting a recent task force dedicated to ousting healthcare providers who direct patients toward ACA plans instead of Medicare and Medicaid in order to receive greater reimbursements.

  • “Creating space for insurers to creatively design their insurance products, particularly for ‘benchmark’ federally-subsidized health plans.”

  • “Restructuring how medical loss ratios are calculated.”

  • “Ending the current rule that bans insurers from entering exchange marketplaces for up to five years if they exit a marketplace.”

  • “Ascertaining whether user fees should be allocated toward outreach efforts.”

    To read a longer article on this, please hit this link.

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