Health policy experts on both the left and the right need to take a deep breath and re-direct their collective energy to suggesting ways to improve the current regulatory environment. No industry stakeholder can say with a straight-face that the individual health insurance markets are functional. It is well-accepted that the markets are unbalanced. And it is well-established that the unbalanced markets are resulting in financial losses for insurance companies and premium increases for consumers.
Is this the Republicans’ fault? No. Is it the Republicans’ problem? Yes. As a result, once portions of the ACA are repealed in the coming weeks, Republicans will undertake efforts to improve the current regulatory environment. How? First, it is likely that Congress will fund the “cost-sharing” reduction subsidies for 2017, 2018, and likely 2019.
Second, Congress and the Administration will attempt to stabilize the individual insurance markets by requiring pre-verification before a person can enroll in an ACA Exchange plan during a “special enrollment period”; changing the 90-day grace period in cases where a policyholder fails to pay their premiums; prohibiting 3rd parties from paying premiums on behalf of certain consumers; providing more flexibility for insurance companies under the Medical Loss Ratio rules; continuing payments under the “reinsurance” program for 2016 (not to be confused with the “risk corridor” program); fixing the “risk adjustment” formula; and modifying the age variant for developing premium rates from a 3-to-1 to a 5-to-1 ratio. In addition, it is likely that funding will be provided to cover high-risk individuals – through high-risk pools or other means.
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