Duke University Margolis Center for Health Policy Research Associate Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule

Targeted News Service

WASHINGTON, Aug. 4 -- David Anderson, research associate at the Duke University Robert J. Margolis Center for Health Policy, Durham, North Carolina, has issued a public comment on the Centers for Medicare and Medicaid Services proposed rule entitled "Patient Protection and Affordable Care Act: Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Proposed Rule". The comment was written and posted on July 28, 2021:

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I would like to comment on matter CMS-9906-P, Patient Protection and Affordable Care Act: Updating Payment Parameters, Section 1332 Waiver, Implementing Regulations and Improving Health Insurance Markets for 2022 and Beyond Proposed Rule.

I am a research associate at the Duke University Robert J. Margolis Center for Health Policy with a research focus on the Affordable Care Act. I would like to comment on several matters.

1. We also propose to repeal the separate billing regulation at Sec. 156.280(e)(2),

I am supportive of reducing administrative burden for enrollment and maintenance of enrollment in the FBM and SBMs. Some of my current, ongoing research has found that the requirement to set up a single payment account for positive, non-zero premium plans can lead to significant enrollment loss due to a significant non-financial transaction and hassle cost./1

Prior research has found, on Healthcare.gov, the presence of a zero premium plan led to a 14% increase in enrollment for individuals earning between 151-200% Federal Poverty Level within a county./2

While these studies do not speak directly on the matter of $1 separate payment for non-Hyde voluntary abortion coverage, they do speak on the importance of minimizing transaction costs for individuals who have expressed a concrete preference to initially enroll and then maintain enrollment in health insurance coverage.

2. We propose extending FFE open enrollment to end on January 15 of the applicable year, rather than December 15 of the previous year beginning with the 2022 coverage year and beyond.

While I have advocated for extending open enrollment periods (OEP) to span the New Year in order to give households an opportunity to correct good faith errors as well as change choices after automatic re-enrollment is effectuated, I believe that the department would be wise to delay implementation of this proposed change until the 2023 coverage year./3

Insurers have already filed initial rates and QHP applications. There is a very short window to update modest errors and make minor strategic changes. An extended open enrollment period that spans the New Year will lead to a significantly different composition of the risk pool, while also changing marketing requirements and customer support needs. An unanticipated policy shock could lead to significant administrative costs for insurers. I recommend the inclusion the extended OEP in the upcoming proposed 2023 NBPP.

I also recommend that a new Special Enrollment Period (SEP) be created for a restricted class of individuals who were automatically re-enrolled into plans that have a net premium increase of at least $10 per member per month in 2022 compared to 2021 as well as a SEP for individuals who had chosen a plan with a positive premium before the end of the current OEP but were unable to effectuate the chosen plan by January 1, 2023. Both SEPs would run to January 15, 2023 with policies becoming active on February 1, 2023. The intent would be to give a second chance for error correction to individuals and households that have expressed a willingness and a preference to purchase insurance but who had been tripped up during the process./1

Sincerely,

David Anderson

References

1. Drake C, Cai S-T, Anderson D, Sacks DW. Financial Transaction Costs Reduce Benefit Take-Up: Evidence from Zero-Premium Health Plans in Colorado. Social Science Research Network; 2021. doi:10.2139/ssrn.3743009

2. Drake C, Anderson DM. Terminating Cost-Sharing Reduction Subsidy Payments: The Impact Of Marketplace Zero-Dollar Premium Plans On Enrollment. Health Aff (Millwood). 2020;39(1):41-49. doi:10.1377/hlthaff.2019.00345

3. Drake C, Anderson D. Next Year, Extend Open Enrollment Of The ACA Marketplaces Into January. Published February 18, 2021. Accessed July 28, 2021. https://www.healthaffairs.org/do/10.1377/hblog20210211.159357/full/

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The proposed rule can be viewed at: https://www.regulations.gov/document/CMS-2021-0113-0002

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