Worried about the nearly 20 million people who buy their own health insurance policies, the Trump administration and congressional Republicans are weighing how to stabilize a wobbly market, government and industry officials say.
The goal is to soothe jittery insurance companies that may bolt next year, while reassuring consumers anxious about the future. That could also buy time for more ambitious GOP attempts to rework the health care law.
Some of the changes can be carried out single-handedly by the new administration, but others may require congressional action or cooperation.
The measures would affect not just those consumers on the subsidized marketplaces under “Obamacare,” but also people purchasing directly from an insurer or through an independent agent. The two groups have become intertwined. This year’s sharp premium increases in the health law markets also hit consumers buying individual policies on the outside, but they are not eligible for financial assistance from the government.
No final decisions appear to have been made. Trump administration officials would not comment ahead of an expected Senate vote on confirming Georgia Rep. Tom Price as the new health secretary.
But a Republican congressional aide familiar with the internal discussions said the regulatory changes that the administration is considering include:
Tightening rules for “special enrollment periods” that allow consumers to sign-up outside of the standard open enrollment window. Insurers have complained that some people take advantage of such opportunities to get coverage when they need care and later drop out, raising costs for everyone else.
Loosening a provision of the Affordable Care Act that prevents insurers from charging older customers more than three times the premium for young adults. It’s unclear how this would happen, since the limitation is specified in the law. But the GOP aide said the administration might be able to find wiggle room. Before the Obama health law, insurers routinely charged older customers five times or more what younger people paid. The ACA has made insurance more affordable for older adults, but critics say that’s pricing out the young and healthy. AARP is already mobilizing to try to head off any attempt to make older customers pay more.
Shortening the 90-day grace period to pay premiums for consumers who get subsidized coverage. Insurers complain this makes it easier for people to game the system.
Shortening the current health law sign-up season, which runs about 90 days.
Relaxing rules on how insurers structure their networks of hospitals and doctors. Republicans tend to think those should be set by states.
The GOP aide spoke on condition of anonymity to discuss internal deliberations. Another person familiar with the administration’s thinking said the points were on target. The regulatory changes mirror requests by insurers, who argue they would help check premiums.