CMS issues ACA final rule, releases enrollment report

Earlier this year, Congress was unable to reach agreement on repeal and replacement for the Affordable Care Act (ACA). However, through regulatory actions and the 2017 tax bill, the Trump administration continues their efforts to dismantle the legislation.

The Centers for Medicare & Medicaid Services (CMS) released data last week on the 2018 six-week open enrollment period. Nationally, approximately 11.75 million people enrolled through the marketplace. South Dakota’s enrollment was 29,652, slightly up from 2017 despite the much shorter enrollment period. Of those South Dakotans who purchased insurance, the highest number of enrollees were in the 55 to 64 years of age bracket. Slightly more women than men purchased health insurance coverage. Depending upon which level of insurance was purchased, more than 85 percent of South Dakotans received insurance premium assistance.

For the 2019 enrollment period, CMS issued a final rule last week giving states flexibility in selecting essential health benefits (EHB) under the ACA. States can build their own set of benefits to be used as a benchmark plan for EHBs, subject to new requirements. The rule allows states to loosen the current regulations on the medical loss ratio, which requires that payers spend at least 80 percent of premium income on health care and quality improvement. It is noteworthy that premiums rose sharply for 2018 in part due to the Trump Administration’s decision not to fund cost sharing reductions, which provided some low income enrollees additional financial breaks or savings on health care expenses, i.e. lowering the amount for deductibles, copayments and coinsurance on health insurance.

In addition, the tax bill removed or zeroed out the penalty, starting in 2019, for those who choose not to get insurance. CMS also issued new guidance to expand ACA’s hardship exemptions to include people who live in counties with no or only one insurer offering plans.