Insurers say Trump must do more to stabilize 'Obamacare'

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.

The final rule, an update of changes proposed on February 15, would make a variety of changes, including cutting down on the amount of time people have to enroll for plans on the exchanges and allowing insurers to collect unpaid premiums before allowing a patient to sign up the next year.

Marilyn Tavenner, president and CEO of America's Health Insurance Plans, the trade group representing health insurers, said in a statement "there is still too much instability and uncertainty in this market".

The future of the cost-sharing subsidies, estimated at $7 billion this year, is under a legal cloud.

A shortened sign-up window of 45 days, starting with coverage for 2018.

-Curbs on "special enrollment periods" that allow consumers to sign up outside the normal open enrollment window. By making such a change, the groups argue, the administration would violate a key part of the health law that requires insurers offer coverage to just about everyone who applies.

The Affordable Care Act enabled 20 million Americans to gain insurance, mostly through the individual insurance markets set up by the law or through an expansion of Medicaid, the government health insurance programme for the poor and disabled.

Limit the 2018 open enrollment period to six weeks, half the previous length: Notably, the rule said CMS and the Department of Health and Human Services would continue to spend money on outreach to encourage people to sign up. Those subsidies are separate from the better-known premium subsidies that most customers receive.

In a Wall Street Journal interview this week, Trump raised the possibility of shutting off the money if Democrats won't bargain on healthcare. Insurers say loose enforcement of these periods has been an expensive problem because it also allows people to game the system.

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-Giving insurers more flexibility to design low-premium plans that can be tailored to young adults.

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.

Moreover, the rule gives states broader authority by removing the federal government's role in overseeing doctor and hospital networks included in insurance plans.

Most communities will have competing insurers on the public marketplace next year, but a growing number will be down to one, and some areas may face having none.

All eyes are now on Anthem, a big Blue Cross-Blue Shield insurer operating in several states that has yet to announce its intentions for 2018. Chief Executive Joseph Swedish has said his company would not commit to participating next year.

Rep. Frank Pallone, the ranking Democrat on the House Energy and Commerce Committee, said that the new rule "will not produce any meaningful improvements for the stability of the ACA Marketplace" and said aspects of the rule would prove negative.

Dave Dillon of the Society of Actuaries says growth in underlying medical expenses could drive coverage prices up 10% or more.

The cost-sharing subsidies were defended by Rep. Greg Walden, R-Ore., who said they should be paid because the government made a commitment to insurers. A U.S. District judge found that Congress did not specifically authorize the payments, making the expenditure unconstitutional.

Now, the threat of potential litigation over the healthcare law from states, which takes a page from the Republicans' playbook during the Obama administration, is complicating the Trump administration's efforts to formulate its own approach on health policy outside congressional legislation, according to two conservative lobbyists briefed on internal discussions.

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