Health Industry Leaders Recommend Immediate Actions to Stabilize Health Insurance Marketplace

In Letter to President-Elect Trump, Healthcare Leadership Council Also Outlines Broader Reforms to Strengthen Health Coverage Flexibility, Affordability

WASHINGTON – In a letter to President-elect Trump, leaders from all sectors of the nation’s healthcare industry have recommended specific steps that should be taken immediately to stabilize the health insurance marketplace, while also suggesting policies that should be part of the post-Affordable Care Act health coverage structure.

The letter from Healthcare Leadership Council president Mary R. Grealy emphasizes that current health insurance premium and cost-sharing subsidies must be maintained during any repeal-and-replace transition period in order to protect consumers and ensure market stability.  Other immediate recommended actions include:

• Utilizing a congressionally-directed fund to help offset costs for consumers with serious health conditions, thus stabilizing the insurance risk pool.

• Repealing the Affordable Care Act’s health insurance tax and, in so doing, reducing the cost burden on consumer premiums.

• Restoring regulatory oversight to the states for insurance market rules, rates, network adequacy, and benefit design, believing that states are better equipped to meet their respective consumers’ needs.

• Ensuring that funds from the temporary reinsurance program are disbursed to insurers in 2017. Without these dollars, many insurers will likely have to leave the marketplace, reducing competition and driving increases in premium costs.

• Deferring to state law regarding health insurance premium grace periods and requiring payment of outstanding premiums before re-enrollment in coverage is allowed. The current three-month grace period has resulted in some consumers receiving healthcare services and then dropping coverage before paying premiums, increasing costs for all consumers.

• Ending third party premium payments that incentivize Medicare- and Medicaid-eligible consumers to enroll in the health insurance exchanges instead.

• Modifying the Medical Loss Ratio provisions for health insurance plans so that spending on functions like quality improvement measures and fraud prevention and detection aren’t considered administrative expenses.

• Reducing the number of health insurance exchange Special Enrollment Periods and requiring pre-enrollment verifications for those claiming eligibility for these periods. Today, abuse of Special Enrollment Periods is worsening the risk pool and resulting in higher premiums for consumers.

And, as the Trump administration and Congress develop a redesigned post-ACA health insurance marketplace, Ms. Grealy said in her letter that it should include advanceable, refundable tax credits to help consumers purchase coverage whether in or out of a health insurance exchange, decision support tools – including smart plan-finder tools and out-of-pocket cost calculators – to help consumers compare plan options, and an improved risk adjustment mechanism.

She also wrote that standard plan designs should be eliminated and insurers should have the freedom to develop innovative plan options that can attract new consumers by offering greater flexibility and affordability.  Guaranteed issue of health insurance without coverage limits for those with pre-existing conditions should continue, she wrote, in conjunction with continuous coverage requirements, safeguards against adverse selection, and the creation of a permanent high-risk pool with broad-based and stable funding.