American Hospital Association calls for changes to exchanges

By Maria Castellucci
August 24, 2016 - Modern Healthcare

The American Hospital Association has warned the Affordable Care Act marketplaces lack stability as insurers exit and concern over drastically rising premiums continues.

In an open letter to HHS Secretary Sylvia Mathews Burwell Wednesday, AHA President and CEO Richard Pollack urged the agency to make several policy and operational changes to “stabilize the insurance markets and encourage robust consumer and insurer participation.”

That participation could be jeopardized by several insurers' recent announcements they will pull out of ACA's exchanges. Those changes “will require millions of consumers to find new coverage in 2017," Pollack wrote.

Insurance giants Aetna, Humana and UnitedHealth Group have all said they will drastically scale back participation in plans as they continue to suffer losses.

According to AHA, the key to marketplace stability is “enrolling healthier individuals,” and HHS should take several steps to further this goal.

The group suggested HHS strengthen special enrollment periods by pre-approving their use before the enrollment period begins and implementing consumer protections so those eligible for special enrollment can effectively use their coverage and understand their payment responsibility.

The AHA also supported finalizing changes to the ACA's risk-adjustment program, including use of prescription drug data to help identify diagnoses.

Another area of focus for the AHA was enhancing enrollment on the exchanges. The association said many low-income Americans still can't afford the premiums of plans, and suggested HHS allow hospitals and systems to cover part of the premiums for individuals not eligible for Medicare and Medicaid. The feds asked the healthcare industry last week to submit information about whether hospitals, providers and foundations were steering Medicare- or Medicaid-eligible patients toward the exchanges in order to obtain higher reimbursement rates.

HHS declined to comment on the letter but noted several efforts to stabilize the markets. The agency released an analysis Wednesday that showed premium increases for 2017 plans will still be affordable, although many caveats apply.

AHA also insisted CMS work more with states to develop solutions that will encourage more stability, noting Alaska authorized a state-level reinsurance program with success.

The letter addressed the reportedly skyrocketing premium prices expected on the 2017 exchanges.

“While recent announcements of double-digit premium increases are alarming, we have reason to believe that such increases may be a one-time correction and necessary to stem insurer losses moving forward," Pollack wrote.