CMS Market Stability Rule

Yesterday, the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) issued the first proposed rule in the wake of the President’s Executive Order directing the agencies to modify Affordable Care Act regulations to the extent that they are permitted under the law to make the current system as efficient and as affordable as possible. The proposed rule includes six sets of proposed modifications to the individual and small group market rules.

Perhaps most significantly, the proposal would shorten the individual open enrollment period to be from November 1 to December 15 (instead of January 30) beginning with the 2018 plan year and would allow insurers to require payment of missed premiums for prior plan years before enrolling an individual in new coverage. On the latter, CMS cited data showing that – in 2015 – 21 percent of the individuals enrolled stopped paying their premiums at some point during that year and almost half of those individuals reenrolled in the exact same plans in 2016.

The proposal also would tighten the special enrollment period eligibility and eligibility verification requirements; expand the range of permitted Actuarial Value de minimus variation; and delegate network adequacy determinations to the States.

In addition, the IRS has altered its rules and will no longer reject tax returns that do not answer the question regarding whether the filer had the mandated health insurance, perhaps signaling an intent to not enforce the individual mandate going forward.

Employer Letter on the Tax Treatment of Health Benefits

On Monday, The Council was one of 27 organizations that signed onto a letter sent to the White House National Economic Council and Domestic Policy Council regarding the tax treatment of health benefits. Taxing health benefits by capping the individual tax exclusion constitutes a tax increase that will drive up out-of-pocket costs for employees and their families, risking disruption to the stable, employer-based system, and threatening the benefits working families enjoy and want to keep.

This policy would discourage lower-wage workers from enrolling in employer-provided insurance, potentially leaving them vulnerable and uninsured or in unstable individual market plans.

Read the letter and distribute to your clients as you see fit.

Comparison of ACA replacement plans

This document, prepared by our legal team at Steptoe & Johnson, provides a comparison of the five major ACA replacement proposals highlighting key issues. Feel free to share with your clients.

Health Merger Update

Anthem is suing to block Cigna from terminating its merger agreement. The announcement of the lawsuit was made this morning in an effort by Anthem to keep alive the $54 billion takeover of Cigna.

Last week, a federal judge blocked Anthem’s proposed acquisition, ruling that the deal would be anti-competitive.