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AHIP, insurers criticize proposed ACA marketplace reforms

Aetna, UnitedHealth, host of others weigh in on Notice of Benefit and Payment Parameters for 2017

Healthcare industry stakeholders--and particularly, insurers--have a lot to say about the government's proposed host of reforms for the Affordable Care Act marketplaces.

Companies, organizations and individuals weighing in on the Centers for Medicare & Medicaid Services' Notice of Benefit and Payment Parameters for 2017 submitted a total of 515 comments about the proposed reforms. One expert called the proposal  "an aggressive move to strengthen regulation of the market," and include more stringent rules regarding health plans' provider network adequacy, as well as other consumer-focused protections, FierceHealthPayer has reported.

But the health insurance industry is concerned about the potential consequences of some of the government's proposals, America's Health Insurance Plans (AHIP) wrote in a letter submitted as one of the public comments. For example, the Department of Health and Human Services "should defer to the expertise of state insurance regulators on network adequacy to assure consumer choice of high-quality coverage options, including high-value and tiered network plans," the group writes.

Indeed, the National Association of Insurance Commissioners recently drafted a model law for states that proposes network adequacy controls.

Aetna echoed these concerns about what it deemed inflexible narrow-network controls, among other concerns with the government's proposals. "Unless some fundamental flaws are corrected, we believe there is a grave risk that the federal exchange will not operate as a viable, competitive market in 2017," it wrote in a comment letter.

AHIP also criticizes what it called an "unwarranted attempt at market engineering by the federal government" in the form of proposed rules regarding rating and service area size, as well a broad certification authority on the part of HHS to determine which qualified health plans are in the "best interest" of consumers. It did, however, praise proposed reforms that promote stability in benefit packages and prescription drug coverage and those that make targeted changes to the risk adjustment program.

For its part, UnitedHealth Group suggested that the exchanges must be stricter about who is allowed to enroll in health plans during special enrollment periods (SEPs). UnitedHealth cited high-cost consumers enrolling during SEPs when it said in November that it might leave the exchanges in 2017 due to mounting financial losses. The government recently said it would not offer a tax-season SEP this year, as it has in the past.

In addition, a long list of industry stakeholders and advocacy groups--including AHIP, Aetna and several Blues plans--sent a letter urging the government to "develop a system to screen and notify people who have or who are seeking marketplace coverage about approaching Medicare eligibility. The groups support the idea of "pop-up" notifications, but said the concept must go further to include more assistance for consumers, they said.

To learn more:
- access all the public comments
- here's AHIP's letter (.pdf)
- here's Aetna's letter (.pdf)
- here's UnitedHealth's letter (.pdf)
- here's the letter about Medicare eligibility (.pdf)

Related Articles:
Proposed ACA marketplace reforms address consumer, insurer concerns
Insurance commissioners propose more narrow-network controls
UnitedHealth's exchange exit threat: What it means
Keeping it honest: New risk adjustment tracking system comes into play