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Avalere’s Take on the ACA Market Stabilization Rule

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Today, the Trump administration released a proposed rule for market stabilization of the Affordable Care Act (ACA).

The rule’s broad aim, according to Administration officials, is to make changes to the ACA in an effort to help convince insurers to remain in the law’s marketplaces while Congress drafts a replacement plan for the likely to-be-repealed ACA. Today’s proposed rule marks the first formal rulemaking by the Administration on the ACA.

Provisions in the rule address changes broadly endorsed by the health plan industry, including:

  • Changes to special enrollment periods
  • Guaranteed availability
  • Timing of the annual open enrollment period
  • Network adequacy standards
  • Actuarial value requirements

Recent Avalere analysis found that exchange enrollment has fallen well below initial projections. Additionally, Avalere data for 2017 exchange plans has shown that one in three regions in the U.S. will have no competition. Recent analysis also finds an increases in premiums and out-of-pocket costs for consumers in addition to a decrease in PPO plan options.

“Today’s proposed rule is an effort to stabilize the exchange markets until an ACA replacement plan is approved and implemented,” said Caroline Pearson, senior vice president at Avalere Health. “Many health plans have expressed uncertainty about their plans for 2018 exchange markets, and this rule is meant to encourage plan participation. It is unclear, however, whether these changes will be sufficient to ensure all regions of the country have an exchange operating in 2018.”

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