Trump Proposals Could Make Marketplace Coverage More Expensive, Less Accessible

The Trump Administration appears poised to propose, through its rule-making authority, changes for the individual health insurance market that would raise premiums for older Americans, raise deductibles, and make it harder for consumers to enroll in coverage.

The Administration will likely argue that these changes are needed to help stabilize the market. But, like the Administration’s decision to scale back marketplace outreach at the end of the recent open enrollment period, some of the possible changes could undermine stability by shrinking enrollment and making the pool of people with coverage sicker, on average. And they would do nothing to dispel the main source of uncertainty facing consumers with Affordable Care Act (ACA) coverage and insurers offering ACA plans: the looming threat that congressional Republicans will repeal the ACA without enacting a comprehensive replacement.

The proposed rule, which would be open for public comment before being finalized, could include provisions that:

• Raise premiums for older Americans. The ACA requires insurers to charge older Americans no more than three times the premiums they charge young adults. The proposed rule could allow insurers to charge older consumers up to 3.49 times what younger consumers pay, raising their premiums by hundreds of dollars per year.
• Allow insurers to raise cost-sharing charges, including deductibles. President Trump has long complained that deductibles are too high in ACA plans. “Look what’s happening to the deductibles — how high the deductibles are. You [have to] get hit by a Komatsu tractor in order to use it,” he said in 2015. Yet the proposed rule could let insurers offer plans with higher deductibles in 2018.
• Cut open enrollment for 2018 coverage in half. The proposed rule may slash the time people have to sign up for 2018 plans, ending it on December 15, 2017 instead of January 31, 2018. This would likely cause more people to miss the deadline — especially younger people, who tend to sign up later. The change would also concentrate the enrollment period during the holiday season, which insurers have warned could discourage new consumers from signing up. As Florida Blue Cross and Blue Shield noted last year, ending open enrollment in December “forces consumers to make financial decisions when their debt is at its highest levels and their interest in their health is at the lowest.”
• Delay coverage for people seeking a special enrollment period (SEP). SEPs allow people to enroll in or change marketplace plans outside the regular open enrollment period if they experience a major life change such as losing job-based health coverage or having a baby. The federal marketplace already asks most people requesting SEPs to submit documentation of such an event after their coverage begins; the proposed rule could delay people’s coverage until they provide it. Not only would this make it harder for consumers to get coverage when they need it, but the additional hassle would most likely deter younger and healthier consumers. Notably, when the federal marketplace started asking people to submit documentation, younger people were less likely to follow through than older people.

Supporters of the proposals seem unfazed at the impact on consumers. “If . . . maybe fewer people sign up for subsidized coverage, then so be it,” said the Heritage Foundation’s Ed Haislmaier, who worked on health insurance issues for the Trump transition team. “There is a new set of priorities here.” Maintaining access to affordable coverage doesn’t seem to be one of them.