Earlier this week, the Trump Administration released a proposed rule for market stabilization of the ACA designed to help convince insurers to remain in the marketplaces while Congress drafts a replacement plan for the ACA.
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Provisions in the rule address changes such as special enrollment periods, guaranteed availability, timing of the annual open enrollment period, network adequacy standards and actuarial value requirements.
The proposed regulations are meant to entice insurance companies to stay in the markets by reducing the number of days people have to sign up and by requiring more documentation of eligibility.
Kent Bottles, MD, Thomas Jefferson University College of Population Health, says the news brings into sharp focus the difficult balancing act that the GOP has to tackle since it has repeatedly announced that it wants to repeal the ACA.
“The problem with repealing the ACA is that it would take insurance away from about 20 million Americans who recently achieved coverage. They will be mad if that happens,” he says. “The Republicans have also not revealed what they would replace the ACA with, because no matter what they decide on, there will be winners and losers under a new system. Insurance companies need to decide soon if they will sell on the exchanges in 2018 and are nervous because they don’t know what rules will apply.”
Bottles says there are two schools of thought from doctors on the issue: one is most concerned about physician autonomy and physician income and they have never been big fans of the ACA. Another group likes the ACA in that it has provided many of their patients with insurance for the first time. This means that these doctors get paid something rather than giving charity care.
Interestingly enough, a 2017 New England Journal of Medicine survey of primary care physicians found that only 15% wanted to repeal the ACA. It did note that there are things that need to be improved in it, but most physicians believed it has helped their patients.