Biden Admin Officials Defend Standardized Plan Requirements

by Leslie Small

Although health insurers may not approve of all the recently proposed policies for the Affordable Care Act exchanges — in particular, the reintroduction of standardized plans — the Biden administration is sticking to its guns.

That was one of the main takeaways from a discussion during AHIP’s 2022 National Conference on Health Policy and Government Programs, which took place virtually from March 14 through 17. During a March 15 session, Ellen Montz, Ph.D., who is the deputy administrator and director of CMS’s Center for Consumer Information and Insurance Oversight, highlighted three parts of the 2023 Notice of Benefit and Payment Parameters (NBPP) that she said will reinforce CMS’s goal of making the exchanges more consumer friendly.

Similar policy was tried before

• Most controversially, CMS has proposed requiring qualified health plan issuers operating on HealthCare.gov to offer a standardized plan at every network type and metal level — as well as throughout every service area — where they also offer non-standardized options.
• The Obama administration had previously introduced — but didn’t require — standardized plans on the federal marketplace that received deferential display and featured fixed deductibles, out-of-pocket limits, and copayments or coinsurance. But the Trump administration rolled back the policy.
• Yet in comments issued about the proposed NBPP, AHIP and the Association for Community Affiliated Plans urged CMS not to move forward with its new, stricter standardized plan requirements. Doing so would hamper benefit design innovation, would be challenging for insurers to implement and could be confusing for consumers, insurers argued.
• Montz, however, said CMS believes that requiring standardized plans will further its goal of helping consumers better understand the differences across plans. “Folks always go to premiums, but when you have the same cost-sharing structure across plans, if you’re a consumer you can better get at, what is the difference across issuers — what makes the most sense for me?” she said.

Officials want to tackle ‘choice overload’

• Montz pointed out that CMS in the 2023 proposed NBPP also sought comment on how to remedy “choice overload” in the individual market.
• “Issuer competition is incredible and drives better outcomes for consumers. But I think we can all agree that in some places across the country, there are too many plan choices — so the difference between issuer and plan here is important,” she said. “And you get to a point where there’s just not a meaningful way for a consumer to tell the difference between plans.”
• Montz also highlighted the fact that CMS in its proposed rule is reviving a previous policy of enforcing network adequacy standards on exchange plans but “with a new focus, based on applying quantitative time and distance standards and appointment wait time standards to ensure that all of our consumers have adequate access to providers within networks.”

From Health Plan Weekly

Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.