In public comments to the federal government, Americans are giving the Trump administration an earful about its proposed rule changes for the Obamacare marketplaces.
Plagued by price increases, a lack of competition in some areas and not enough young and healthy enrollees, the Department of Health and Human Services proposed multiple rule changes designed to shore up the insurers’ finances and bring more people into the marketplace.
The proposed rules, which would take effect next year, would cut the marketplace enrollment period in half —from three months to 45 days. According to the Trump administration, doing so would reduce the opportunity for people to enroll in coverage after they become ill, and it would bring more healthy people into the pool of covered individuals.
The proposals would also allow policies to cover a lower portion of medical costs and require more intensive screening of applicants seeking coverage in the special enrollment period.
And they would allow insurers to apply premium payments to a plan members’ unpaid premiums if they’re owed to the same insurer. Insurers could also refuse to activate new coverage because of past-due premiums “assuming state law does not prohibit such action.”
While health advocates said the proposals would weaken or reverse valuable consumer protections in the Affordable Care Act, insurers support the measures.
But in hundreds of public comments pouring into the federal government, consumers have been overwhelmingly critical of the rule changes, especially cutting the marketplace enrollment period in half.
The public has until March 7 to submit comments. Final rules are likely to be issued in March or April before insurers begin submiting their health plan options for 2018 to state regulators.
In her comments, Shannon Macdonald of Alaska called the shortened enrollment period “ridiculous.”
“Six weeks is not enough time for all the people that qualify for the Healthcare Marketplace to be able to make informed insurance choices,” Macdonald wrote. “The Healthcare.gov website can barely keep up with the amount of people enrolling during a 3 month open enrollment time period. Shortening the open enrollment will also overload (certified application counselors) and navigators, as well as the call center.”
Larry Robinson, an insurance broker for 33 years in the Atlanta area, said the shorter enrollment period will make it harder to correct mistakes with plan selections and adjust for insurer changes.
“If there are substantial carrier changes, it is impossible for the government or private sector to answer all the questions, and assist with all of the enrollments in a 6-week period of time,” Robinson wrote.
Roger Barrus of Texas called the proposal a “a thinly veiled attempt to cut the ACA to the quick.” “Reducing enrollment periods are just making it more difficult for people to get health insurance. It will do nothing to stabilize the market. This is just wrongheaded,” Barrus wrote.
Not all comments were negative. Bruce Telkamp, CEO of HealthPocket, a health insurance research firm in California, said his company “strongly supports” Trump’s rule changes.
“HealthPocket believes that the Proposed Rule will improve the quality of ACA risk pools and reduce the likelihood of further significant increases to ACA premiums and deductibles that have been harmful to consumers,” Telkamp wrote.
Lee Brown of Ohio said it’s not the federal government’s responsibility to “provide or assure that all citizens have health insurance.”
“It is every citizen’s right to choose if they want to manage their financial risk with the purchase (of) health insurance. Failure is a basic right,” Lee wrote. “Repeal the ACA. It does not need to be replaced. Allow health insurance markets to return to pre-ACA rules.”
Brown and Telkamp, however, were a distinct minority among the public comments.
Dr. Samantha Malm, a family physician from Berkeley, Calif., expressed concern about allowing insurers to halt coverage for delinquent plan members.
“Although the proposed change sounds reasonable, it ultimately is a barrier to people obtaining coverage. Because there is a limit to how much debt a person can accumulate before they lose their coverage, it is possible to account for this potential loss when calculating premiums. I realize this drives up premiums for everyone, but if a person’s financial situation improves and they are again able to afford insurance, I would not want an outstanding debt to be an obstacle to doing so.”
Some commenters, like Sue Decker of Wisconsin, just wanted to express their anger.
“Why don’t you simply come out and say that you want poor people to just get out of the way and die, while giving as much of their money to the ‘health’ industry as possible,” Decker wrote.
Sharon Greenwood of Missouri took a less-than-subtle shot at President Trump.
“Why do you want to make it so hard for me and my husband to get health insurance?” Greenwood wrote. “You have money and power, something you neither earned or deserve, and to use it to shorten the life spans of Americans is abhorrent.”
Tony Pugh: 202-383-6013, @TonyPughDC