On Monday, CMS published a number of policies changing the dynamics of the individual market, including the Benefit and Payment Parameters for 2019 Final Rule, guidance on hardship exemptions, and a bulletin on transitional (grandmothered) plans. When interpreting all of these policies it’s important to keep in mind the following: What is success? And who is defining it?
The Obama Administration managed ACA implementation with the clear intention of making sure the outcome met the goals of the law: more people covered, more choices of coverage for those people, and lower premiums. While the success of their efforts can be debated, the intention was always known.
For the Trump Administration, it is not necessarily clear how successful implementation of this next rule will be judged. Are they trying to maximize the number of people covered, maximize the number of choices available or lower premiums? What is the organizing principle? Is it as simple as providing additional regulatory flexibility?
There are two other stakeholders who also have to determine their definition of success in the face of this rule: states and insurers. For states, they will have to determine if and how they will use the additional flexibility granted to them under their rule. Insurers, with the loss of the individual mandate and CSRs, and the looming threat of STLDIs and AHPs, have to decide if the rule provides a stable environment for participation.
From now through the start of the next open enrollment period, we expect significant backstage drama as insurers, states, and the Administration answer these questions. The offerings and premiums available to Americans six days before the midterm elections depend on these decisions. Continue Reading CMS Benefit and Payment Rule: What is Success for the ACA?