The Trump administration has unveiled a sweeping set of regulatory proposals that would substantially change health plan offerings on the Affordable Care Act marketplace next year, aiming, it says, to provide more choice and lower premiums. But it also proposes sharply raising some annual out-of-pocket costs — to more than $27,600 for one type of coverage — and could cause up to 2 million people to drop insurance.
The changes come as affordability is a key concern for many Americans, some of whom are struggling to pay their ACA premiums since enhanced subsidies expired at the end of last year. Initial enrollment numbers for this year fell by more than 1 million.
Health care coverage and affordability have become politically potent issues in the run-up to November’s midterm elections.
The proposed changes are part of a 577-page rule that addresses a broad swath of standards, including benefit packages, out-of-pocket costs, and health care provider networks. Insurers refer to these standards when setting premium rates for the coming year.
After a comment period, the rule will be finalized this spring.
It “puts patients, taxpayers, and states first by lowering costs and reinforcing accountability for taxpayer dollars,” said Centers for Medicare & Medicaid Services Administrator Mehmet Oz in a Feb. 9 press release.
One way it would do so focuses heavily on a type of coverage — catastrophic plans — that last year attracted only about 20,000 policyholders, according to the proposal, although other estimates put it closer to 54,000.
“To me, this proposal reads like the administration has found their next big thing in the catastrophic plans,” said Katie Keith, director of the Health Policy and the Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center.
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Such plans have very high annual out-of-pocket costs for the policyholder but often lower premiums than other ACA coverage options. Formerly restricted to those under age 30 or facing certain hardships, the Trump administration allowed older people who lost subsidy eligibility to enroll in them for this year. It is not yet known …