The Trump administration and Capitol Hill Republicans are trying to stabilize the individual health insurance market, hoping to keep insurers from canceling plans or raising rates in 2018 as uncertainty builds over what a replacement for Obamacare might look like.
President Trump, who now says the replacement effort could stretch into next year, recently filed a regulatory notice seeking “market stabilization” under the Affordable Care Act.
The actual text won’t be released until the White House Budget Office vets the proposed changes, but the administration wants to tighten loopholes that have allowed Obamacare customers to obtain care without paying a full year’s worth of premiums, said Edmund Haislmaier, a senior research fellow at the conservative Heritage Foundation who advised Mr. Trump’s transition team.
He said Mr. Trump will likely require Obamacare customers to verify their legal immigration status or other conditions of eligibility before they sign up rather than scrubbing applications after they’re enrolled.
The administration also wants to fully vet people who try to enroll in between the traditional sign-up seasons, or even reduce the number of categories that allow people to qualify for the so-called “special enrollment periods.”
President Obama started to tighten the rules by requiring proof-of-life changes, though insurers say it is still too easy for customers to apply once they need care rather than paying premiums from the start of the year.
Companies often cannot turn a profit on those customers, forcing them to raise rates.
Critics say Mr. Obama’s push to herd as many people as possible into his program ignored safeguards and upset the law’s economics, saddling people who do not qualify for taxpayer-funded subsidies with the full brunt of premium hikes.
“Very clearly, the priorities get reversed and the new administration comes in and says, ‘Look, first thing we have to do is minimize the damage outside the subsidized market,’” said Mr. Haislmaier, who hasn’t seen the proposed rule changes but helped the Trump administration forge its plans after the election.
Efforts to mollify insurers would provide breathing room to Republican leaders who’ve fallen behind schedule in their plans to replace Mr. Obama’s signature health care law.
Lawmakers hoped to repeal most of the law this spring and then sew up its replacement later in the year, though Mr. Trump on Sunday said the timeline could stretch into 2018.
“We are putting in a wonderful plan — statutorily, it takes awhile to get,” Mr. Trump told Fox News’ Bill O’Reilly. “We’re going to be putting it in fairly soon. I would like to say by the end of the year, at least the rudiments, but we should have something within the year and the following year.”
Health and Human Services spokesman Ryan Murphy said Monday he had “nothing more to share” about Mr. Trump’s regulatory moves for now.
In the meantime, the House Energy and Commerce Committee is weighing legislation that dovetails with Mr. Trump’s plans to stabilize the current program.
Proposals would allow insurers to charge older customers up to five times as much as younger ones, instead of Obamacare’s 3-to-1 ratio, so healthier people are more likely to join the risk pool. Another bill would require people to document a significant life change before using the Obamacare exchanges outside of open enrollment.
Republicans also want to crack down on customers who stop paying their premiums. Under Obamacare there is a 90-day grace period before insurers can pull the plug due to nonpayment.
“The 90-day grace period potentially allows a policyholder to incur claims well past the time that premium payments have been discontinued,” Tennessee Insurance Commissioner Julie Mix McPeak warned the Senate Health Committee last week.
A bill by Rep. Bill Flores, Texas Republican, says that period should be slashed to one month, or whatever each state had in place before Obamacare revamped the individual market, so customers don’t game the system.
Sen. Christopher Murphy, Connecticut Democrat, said both parties could agree on ways to tighten the enrollment process or bolster risk programs that mitigate insurers’ losses, but not if Republicans want to scrap Obamacare first.
“I don’t think there will be Democratic votes to tape back together this glass vase,” he said, “after they shatter it into a million pieces.”
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