Senior Policy Analyst
A proposed Trump Administration rule would undermine the Affordable Care Act (ACA) and could cause many people to lose health coverage. If finalized, the Notice of Benefit and Payment Parameters (NBPP) for the 2022 coverage year would encourage privatization of core functions of the health insurance marketplaces, starve HealthCare.gov of needed funds, codify Administration efforts to waive important parts of the ACA, and continue a policy that raises premiums and cost-sharing. Comments on the rule are due December 30 and can be submitted here.
The proposed rule doubles down on the Administration’s November 1 approval of Georgia’s marketplace privatization waiver by letting any state follow suit without a waiver. Under Georgia’s 1332 waiver (named after section 1332 of the ACA), the state will leave HealthCare.gov and require its marketplace enrollees to enroll exclusively through private web brokers or insurers.
This scheme will reduce coverage among the 500,000 Georgians who now enroll through HealthCare.gov, without a broker. For starters, many people will likely fall through the cracks in this massive change due to confusion about the new process. That’s what happened in states that shifted from the federal marketplace to a state-based marketplace or vice versa, a transition much simpler for consumers than what Georgia is attempting.
Also, consumers will lose access to HealthCare.gov’s apples-to-apples plan comparisons. Instead, they’ll have to rely on profit-driven entities, which can withhold essential information (like premiums and deductibles) for plans that don’t pay them commissions, forcing consumers to do significant legwork if they want to explore those options. And these entities sometimes steer people to short-term and other subpar plans and discourage Medicaid enrollment.
By encouraging more states to follow Georgia’s lead, the NBPP would likely cause more loss of coverage and divert more people to subpar plans.
The NBPP would also encourage enrollment assisters and navigators to use enhanced direct enrollment (EDE) websites – websites from private brokers authorized to directly enroll people in marketplace plans – instead of HealthCare.gov and let EDE websites operate for up to a year without meeting marketplace requirements for presenting materials in languages other than English.
The NBPP also would: