Health Center Regulatory Issues, Health Center State Policy

Uncertainty Remains in the Marketplace

On April 13, 2017 CMS issued its final rule designed to make the ACA Marketplaces more appealing to insurers.  Under this final rule, starting for the 2018 plan year:

  • The annual Open Enrollment Period will be shortened from 3 months to 6 weeks
  • States will have full authority to determine if an insurer’s network has an adequate number of providers
  • Insurers will be required to include only 20 percent of Essential Community Providers (also known as ECPs and includes heath centers) in their networks, down from the previous requirement of 30 percent.
  • People will need to prove that they qualify for a Special Enrollment Period

However, even with this final rule to stabilize the Marketplaces, there is still much uncertainty of what will happen with the Cost-Sharing Reductions, which remain in flux.

By way of background, cost sharing reductions are discounts that lower the amount an individual must pay for deductibles, copayments and coinsurance, available for individuals or families up to 250 percent of poverty.  In 2014, the House of Representatives filed a lawsuit against the Obama Administration claiming that Congress never authorized spending for Cost-Sharing Reductions.  The Courts originally agreed with the House of Representatives and the Obama Administration appealed the decision, which led the Court to allow the Cost-Sharing Reductions to continue until the case is resolved.

It is not certain how this will be resolved, but there is much discussion about potential next steps.  If the Trump Administration chooses to continue the appeal, the Cost Sharing Reductions would continue as long as the appeal is being considered.  At the same time, there is talk that Congress could authorize the Cost Sharing Reductions through an Omnibus or Continuing Resolution package.  On the other side of either of those options, if the Trump Administration does not continue the appeal and Congress does not act, the Cost Sharing Reductions could immediately end, leaving the insurers in the Marketplace to cover the cost of the Cost Sharing Reductions on their own, which could lead to many dropping out of the Marketplaces.

While much of this remains in flux, NACHC has joined other safety net coalitions in letters to both the House and Senate Leadership and President Trump encouraging the continuation of the Cost Sharing Reductions in order to ensure access to affordable health care.  We will continue to watch this very closely and will continue to provide updates as there are new developments.