Supporters of Medicaid and the Affordable Care Act (ACA) have hosted events like marches, town halls, rallies, legislative visits, call-ins, letter-writing campaigns and others, to show our leaders in Congress how important health care is for ALL of us. And it’s working! Each day, we are holding Congress accountable for their inadequate replacement plan and their leaked policy proposals that would result in health insurance that covers fewer people, costs more and dramatically cuts our state’s federal funding for Medicaid. This one-two punch almost guarantees middle-class and low-income Coloradans will lose affordable health coverage, leaving them worse off than they were before. But we have to be just as vigilant and active in opposing changes through regulation that would also undermine Coloradans access to coverage and care.

Congress holds the power to repeal the ACA and fundamentally change how important programs like Medicaid operate, but the Secretary of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) Administrator hold the keys to important regulations that, if implemented, also pose an alarming threat to Coloradans who depend on the ACA and Medicaid for their care. Less than a week after his confirmation as secretary of HHS, Secretary Tom Price made his first play to undermine coverage under the ACA.

His first set of regulatory proposals reads like the insurance lobby’s wish list: new barriers to enrollment, flexibility in plan design and diminished oversight of plans’ networks. Under the guise of “market stability,” simply put, this proposed rule would make it harder and more expensive for Coloradans to enroll in and keep their coverage. Achieving market stability is a worthwhile goal, but not at the expense of important consumer protections. While the Secretary’s proposals may benefit insurance companies’ bottom line, they will also likely have the perverse effect of reducing total enrollment, and even discouraging enrollment among healthier populations—subsequently exacerbating the very problem they are ostensibly seeking to solve.

Here are the major proposals in this rule:

  • Changes to Special Enrollment Periods (SEPs) – Increased verification/documentation would be required for consumers to qualify for an SEP and enroll in coverage. This will make it more difficult for consumers to enroll when they have a qualifying life event like having a baby, losing coverage, getting married/divorced, etc.
  • “Guaranteed Availability of Coverage” – This misleading title in the regulation would allow insurers to charge consumers for “past debt” owed from unpaid premiums in the previous year before being able to enroll in a plan. This means Coloradans that failed to pay premiums could face a huge cost to re-enroll in coverage, even if they were not at fault for the loss of coverage or unpaid premiums.
  • Changes to the Value of Plans – The regulation proposes to allow insurers to have greater flexibility to provide plans with lower actuarial values (i.e. how much an insurer pays vs. what the consumer pays) and potentially cover less care. This would make receiving care more expensive by raising out-of-pocket expenses for consumers. There are too many consumers that already struggle to cover their out-of-pocket costs. This is also concerning because it would mean that the second to lowest silver level plan, which is the basis for tax credit calculations, could be artificially lowered, diminishing the amount of tax credits available and increasing premium costs for consumers throughout Colorado.
  • A Shorter Open Enrollment Period – The rule proposes to shorten open enrollment by half its duration, to 45 days from November 1st to December 15th, giving consumers less time to select and enroll in coverage. This also is likely to lead to a sicker risk pool and rising premiums, as many younger/healthier individuals have signed up for coverage past the Dec. 15th deadline in previous open enrollments.
  • Network Adequacy Changes – The rule would decrease federal involvement in evaluating insurance networks for adequacy to meet the needs of the population under that plan, relying on state-level reviews, and potentially weaken standards for inclusion of “Essential Community Providers (ECPs).” ECPs are often important anchor providers in communities and usually include lower cost federally qualified health centers (FQHCs), rural hospitals, and community clinics that are important sources of care for consumers.

CCHI is submitting comments with our concerns about this proposed rule to CMS to protect consumers from these many harmful changes. This is the first attempt at changes to the ACA through the regulatory process, but is assuredly not the last. CCHI will continue to advocate for consumers through regulations and stand by our principles for more affordable, equitable, and high quality health care. You can submit comments with your concerns about this regulation here.

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