10 ways the Trump administration proposes to loosen ACA market rules

By Harris Meyer  | October 30, 2017

The CMS Friday issued a proposed rule to carry out President Donald Trump's January executive order to relax Affordable Care Act requirements on consumers, insurers and other healthcare industry groups.

The agency said the goal is to give states greater flexibility to take steps to stabilize the individual and small-group insurance markets and increase health plan affordability. The rule would take effect in 2019. Public comments are due by Nov. 27.

The Trump administration hopes to relax ACA rules and expand state authority as much as possible through administrative action, following the collapse of congressional GOP efforts to make such changes legislatively.

These are some of the biggest changes included in the 365-page proposed rule.

1.     States could replace their benchmark plan defining minimum essential health benefits with all or part of 

another state's benchmark plan.

2.     States could establish a new benchmark plan for essential health benefits as long as it's equal to the scope of benefits provided under a typical employer plan. Typical is defined as any employer plan in the small-or large-group market with at least 5,000 employees.

3.     HHS would defer to state review of the adequacy of health plan provider networks and expand the role of states in certifying qualified health plans offered on the federal insurance exchange.

4.     States could lower the ACA requirement that individual-market health plans spend at least 80% of premium revenue on medical costs, if they demonstrate that a lower medical loss ratio would help stabilize the market.

5.     Health plans proposing to raise premiums would not be subject to regulatory review for "unreasonable" increases unless the proposed hike is 15% or more, compared to a 10% threshold now.

6.     Each ACA exchange would no longer be required to have at least two enrollment navigator organizations. And there no longer would have to be at least one consumer-focused not-for-profit navigator group with a physical presence in the local area.

7.     The federal exchange no longer would maintain a website and payment platform for the Small Business Health Options Marketplace, or SHOP. State-based SHOP marketplaces could continue if they choose to do so.

8.     Standardized health plan options, created by the Obama administration to simplify consumer choice on the exchanges, would be eliminated. The CMS said this would encourage innovation.

9.     Consumers who relocate or get married would have to demonstrate prior coverage during the previous 60 days to qualify for special enrollment outside the open enrollment period.

10.  

Hardship exemptions waiving the requirement that people buy coverage would be expanded by basing the affordability test on the cost of a silver plan if no bronze plan is available in that market.

Harris Meyer is a senior reporter providing news and analysis on a broad range of healthcare topics. He served as managing editor of Modern Healthcare from 2013 to 2015. His more than three decades of journalism experience includes freelance reporting for Health Affairs, Kaiser Health News and other publications; law editor at the Daily Business Review in Miami; staff writer at the New Times alternative weekly in Fort Lauderdale, Fla.; senior writer at Hospitals & Health Networks; national correspondent at American Medical News; and health unit researcher at WMAQ-TV News in Chicago. A graduate of Northwestern University, Meyer won the 2000 Gerald Loeb Award for Distinguished Business and Financial Journalism.

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