Skip to main content
off the charts

Enzi Proposal Would Threaten Market Reforms in Affordable Care Act

The Senate is expected to vote today on a proposal from Senator Mike Enzi (R-WY) to overturn federal regulations related to some of the Affordable Care Act’s key health insurance market reforms that took effect last week.

The regulations define “grandfathered plans.”   Here’s why this definition matters.  Among other things, the new health reform law would require health plans to cover preventive care without cost-sharing, undergo reviews to see if their premium rate increases are unreasonable, and offer enrollees the choice of their primary care provider.  But plans that existed when the law was enacted on March 23, 2010 — known as “grandfathered” plans — aren’t required to comply with these reforms.

The regulations define how much a grandfathered plan can change before it is considered a new plan that must abide by these new reforms and consumer protections.  As we explained in a recent fact sheet, they strike a good balance for consumers, allowing people to keep the plans they have while ensuring that consumer protections kick in if an insurance company reduces a plan’s benefits or raises consumers’ out-of-pocket costs significantly.

Repealing the regulations, as Senator Enzi is proposing, would confuse consumers, employers, and insurers about which plans are grandfathered and which plans have to comply with market reforms.  As a result, it would threaten the implementation of the immediate market reforms, thus making the insurance market less stable and would likely leave many consumers without access to critical protections the Affordable Care Act provides.

In short, the Enzi proposal — which would require just 51 votes to pass — would be a significant step backward.