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Health Rules Boost ACA Standards, Access to Quality Coverage

May 7, 2024: This post has been updated.

The Biden Administration recently finalized several rules that strengthen Affordable Care Act (ACA) standards and ensure people can enroll in affordable, high-quality health coverage. 

On April 29, the Department of Labor rescinded a problematic 2018 rule on Association Health Plans, which a federal court previously invalidated. The old rule let trade associations, professional groups, and other organizations sell health coverage to individuals and small businesses without meeting the cost and benefit standards set by the ACA.

Another recently finalized rule ensures that “short-term, limited duration” plans can only be offered, as their name suggests, for a short term. The new rules return the initial term of a short-term plan to a maximum of three months, with the possibility to renew coverage for one additional month. Trump-era rules sought to expand short-term plans and promote them as an alternative to comprehensive plans, even though “short-term” plans can deny coverage or charge higher prices to people with pre-existing conditions and often leave out benefits such as maternity and mental health care.

The Biden Administration also made crucial changes to the rules that implement section 1557 of the ACA, protecting people from discrimination when they engage with the health care system and use their health care coverage — regardless of their race, national origin (including immigration status and native language), sex (including gender identity, sexual orientation, and presentation), disability, and age.

Two rules the Biden Administration finalized earlier in April will improve people’s access to health care through Medicaid and the Children’s Health Insurance Program (CHIP), including by increasing transparency in how states set payment rates to providers, reducing appointment wait times for managed care enrollees, and giving enrollees a greater voice in guiding Medicaid policy. Another recently released rule will help streamline eligibility and enrollment processes for Medicaid and CHIP, making it easier for people to get enrolled and stay enrolled.

And another rule made permanent a monthly special enrollment period for ACA marketplace plans, which allows people with income up to 150 of the federal poverty level to enroll in a plan and access financial assistance throughout the year. The rule also creates nationwide standards for health care provider networks and strengthens the process for states seeking to operate their own marketplaces.

Finally, the Department of Health and Human Services (HHS) ended the bar on ACA marketplace eligibility for people with Deferred Action for Childhood Arrivals and other groups. HHS finalized a rule that will result in approximately 100,000 people qualifying to buy coverage through the marketplace and Basic Health Programs.

Topics:
Claire Heylson
Analista Sénior de Políticas - Políticas de Seguro Médico y del Mercado de Seguros Médicos