Business Insider-Bob Bryan -August 29,2016
The government is offering some ideas to try to fix the Affordable Care Act, the healthcare law known as Obamacare, amid a series of missteps that have befallen President Barack Obama’s signature legislative achievement.
With Obamacare having being dogged by negative news over the past few weeks — as major insurers have pulled out of some public exchanges and regulators have said the exchanges are “near collapse” — the US Centers for Medicare and Medicaid Services, or CMS, proposed a series of changes on Monday to try to correct some of the exchange issues.
CMS, the division of the US Department of Health and Human Services that oversees the exchanges, proposed tweaks that would make it less risky for insurers in the marketplace to take on sick patients.
Two of the biggest problems for the exchanges have been a lack of young people, who help offset higher-cost patients, signing up for insurance and generally sicker-than-expected people getting coverage through the exchanges, leading to huge losses for some insurers.
A few of the 14 total proposals include:
- Using some of the fees from the federally funded marketplace for outreach to get more young people to sign up.
- Strengthening rules for signing up for insurance outside the open-enrollment period to ensure that people are not waiting until they are sick to get coverage.
- Take prescription-drug use into account when evaluating the risk profile of potential patients. Previously, this had not been taken into account, and insurers argued that it prevented them from getting a full picture of possible patients’ health status.
- Creating more flexibility for insurers in their bronze plan offerings to reduce cost burdens.
Kevin Counihan, the insurance marketplace CEO at the CMS, said the proposed changes would fix numerous issues with the exchanges.
“These proposed actions and others we have taken over the last six months would help to: support issuers with high-cost enrollees, while updating risk adjustment; strengthen the risk pool; promote additional enrollment; and support issuers in entering the Marketplace or growing their Marketplace business,” Counihan wrote in a post summarizing the proposals.
All of these changes serve as attempts to make it more economically sound for insurance companies to be in the market, to get more people into the exchanges (roughly 10% of Americans are still uncovered), and to eliminate loopholes that allow people to game the exchanges.
The public exchanges are just part of the ACA, representing only 6% of health-insurance coverage nationwide. But, as one of the signature parts of the law, their survival is a huge deal to the long-term future of the ACA.
Comments on the proposals close on October 6.
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