Sabrina Corlette, who studies the individual marketplace for the Center on Health Insurance Reforms at Georgetown University, said the directive could result in fewer healthy enrollees which insurers also would not like and dont address some of the biggest concerns for the industry, such as the fate of federal subsidies that help low-income consumers pay deductibles and other out-of-pocket costs.
Marilyn Tavenner, president and chief executive of America's Health Insurance Plans, responded in a statement that funding for the payments must continue uninterrupted.
Open enrollment for 2018 coverage will run from November 1 until December 15 of this year, half the time period that open enrollment has been offered since the launch of HealthCare.gov. CMS says the changes would allow people to have coverage for the entirety of 2018 and reduce the chance of "adverse selection", when people only buy insurance in the second half of the sign-up period if they learn they're sick.
Insurers say these have been too easily granted, allowing some people to sign up only when they need costly treatment.
The Trump administrations proposed rule aimed at stabilizing the health laws insurance marketplace could have rapid, dramatic effects on people who do not get insurance through work and buy it on the Affordable Care Acts exchanges.
Health insurers are caught in an increasingly uneasy limbo, trying to make decisions about whether to sell plans on the Affordable Care Act marketplaces next year while President Trump dangles the possibility he will actively undermine the business.
The Trump administration released limited fixes Thursday for shaky health insurance markets, even as it reaffirmed its goal of dismantling the Obama-era law that created them and now covers millions. Trump has threatened to withhold the payments as a means to force Democrats to negotiate on health care legislation.
Julie Mix McPeak, the commissioner of the Tennessee Department of Commerce and Insurance, which is at risk of having no insurers in 16 counties next year, said that if the cost-sharing payments were to stop it could be devastating.
-Allowing an insurer to collect past debt for unpaid premiums from the prior 12 months before applying a consumer's payments to a new policy. I don't want people to get hurt... Those subsidies are separate from the better-known premium subsidies that most customers receive.
Americans probably won't know for certain what sort of choices they will have until late summer or early fall, a couple of months before open enrollment begins.
The rule also gives states broader authority by removing the federal government's role in overseeing doctor and hospital networks included in insurance plans. "They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated".
All eyes are now on Anthem, a big Blue Cross-Blue Shield insurer operating in several states that has yet to announce its intentions. Companies are considering leaving more markets for next year because they say they are losing money. Swedish and other insurance officials have said the government has to stabilize the marketplaces.
Dave Dillon of the Society of Actuaries says growth in underlying medical expenses could drive coverage prices up 10% or more.
Nonetheless, the nonpartisan Congressional Budget Office said the ACA markets will be stable next year in most areas.
In Washington, Republicans are trying to resolve an impasse between hardliners and moderates that has prevented them from getting their own healthcare bill through the House. But the cost-sharing reduction issue is only the leading edge of a number of uncertainties that could affect how well the markets function. A U.S. District judge found that Congress did not specifically authorize the payments, making the expenditure unconstitutional.
While Republicans have campaigned for years on a promise to repeal Obamacare, they failed in their initial attempt to rewrite the health law, cancelling a planned vote last month.