CMS Seeks to Strengthen ACA Marketplace After Insurer Withdrawals

In response to the withdrawal of many large insurers from Affordable Care Act exchanges, the US Centers for Medicare and Medicaid Services (CMS) issued new standards to strengthen the exchanges for 2018.

The new standards were issued in the proposed annual Notice of Benefit and Payment Parameters for 2018, which was released early to provide additional certainty to the health insurance marketplace, according to a press release from the CMS. Much uncertainty has resulted from the recent Aetna withdrawal that left many counties with few insurers offering plans for the coming year.

The withdrawal especially hurt some states at the county level, such as Pinal County in Arizona, who are left without any insurers selling Affordable Care Act plans. These people have little options for health coverage; however, people who live in some areas are still facing high premiums, and uncertainty in affording health insurance.

The CMS proposes to combat the uncertainty by strengthening the risk adjustment program, which has recently been scrutinized for an allegedly inaccurate formula. CMS said that modifying this program will protect consumer access to affordable health insurance options.

The proposed rule will modify the program to make it more effective at pooling risk, according to the press release. Beginning in 2017, the proposed rule would more accurately calculate the risk associated with enrollees who lose coverage, or who are not covered for the full year.

The rule would also use prescription drug utilization data to improve the risk adjustment models beginning in 2018, the Centers for Medicare and Medicaid Services wrote. Also, beginning in 2018, the rule would also create transfers to spread the risk of high-cost enrollees with the hopes of improving risk-sharing.

The rule will also give consumers additional resources to compare plans and create consumer protections for those purchasing plans through direct enrollment, according to the press release. The CMS will also be open to suggestions from insurers, consumers, providers, and other stakeholders on how to improve the risk pool.

"Right now, we are preparing to serve millions of consumers with a new set of innovations during the upcoming Marketplace Open Enrollment. As we do this, we are proposing today a set of critical actions based upon our first 3 years' experience that, if finalized, would improve how consumers and health plans interact with the Marketplace," said Acting Administrator of the Centers for Medicare and Medicaid Services Andy Slavitt. "These proposals help fulfill the promise that affordable, quality health coverage can be provided to everyone who needs it."