After a delay, the Department of Health and Human Services (HHS) has issued its proposed annual rule regulating state health insurance markets, including coverage sold through the Affordable Care Act (ACA) marketplaces.
These latest proposed changes could have significant impacts on state insurance markets and would:
- Impose new insurer requirements;
- Reduce premium tax credits; and
- Alter eligibility and outreach requirements for ACA marketplaces.
The rule also proposes changes to — and seeks feedback on — efforts to limit spending on prescription drugs, especially brand-name drugs.
Notably, the rule does not propose immediate changes to state and issuer policies to “silver load” or adjust premium rates to account for the loss of federal cost sharing reduction (CSR) payments — designed to help those with lower incomes afford coverage through the marketplaces. However, language in the proposed rule suggests HHS might take action in a future rule to address silver–loading if Congress does not take action regarding an appropriation for CSR payments.
The proposal also states that HHS also might take future action related to the practice of auto-enrollment in the insurance marketplaces.
The National Academy for State Health Policy has created a summary chart highlighting the provisions that impact states. Time is limited, with comments on the proposed regulation due to HHS by Feb 19, 2019.