AHIP weighs in on benefit, payment parameters for individual market

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In what AHIP calls a push to ensure affordable and quality choices in the federal health insurance marketplaces, the organization for insurers has submitted comments in response to the Department of Health and Human Services' Notice of Benefit and Payment Parameters for 2023, claiming the NBPP includes policies that could undermine stability.

HHS issued the 408-page NBPP on December 28, 2021, and touched on a variety of topics, including a requirement that insurers offer standardized plans, new federal network adequacy standards, heightened standards for the inclusion of community providers in provider networks, LGBTQ nondiscrimination protections, a new framework for discriminatory benefit design, changes to essential health benefits requirements, new display standards for web-brokers, clarification of medical loss ratio calculations, user fees and risk adjustment.

While some of those policies – such as the adoption of standardized plans and protections for premium nonpayment – were previewed in prior rules, others are reversals of Trump-era policies, including the LGBTQ nondiscrimination protections. Many of the changes, such as Medical Loss Ratio (MLR) clarifications, are new.

Not all of AHIP's comments on the NBPP were critical. The group highlighted the increase in marketplace enrollment, with more than 14.5 million Americans enrolling in marketplace coverage for plan year 2022.

AHIP also had positive things to say about the American Rescue Plan, which in the organization's view "made certain that more Americans have choices of coverage with a low or $0 premium, and many can receive more generous subsidies to lower their out-of-pocket costs."

 "The continued stability and growth of the ACA marketplaces is also due in large part to policies that have promoted a stable regulatory environment, increased competition, and enabled issuers to offer innovative products that consumers want and need," AHIP wrote.

However, AHIP also had a number of recommendations.

WHAT'S THE IMPACT?

"We are concerned that some of the policies proposed in this Payment Notice may take large steps backward, undermining this hard-won stability and significantly limiting innovation and competition," AHIP wrote. "Wherever possible, our comments offer workable alternative policy solutions that will achieve similar goals while minimizing disruption for everyone."

One area of focus for AHIP is Essential Health Benefits (EHB) and benefit design. According to AHIP, the proposed nondiscrimination framework is overly broad and "could create a slippery slope of eliminating benefit limits that are based on clinical evidence, support value-based care and ensure affordable premiums." The group said the proposed framework would restrict issuers' ability to design benefits or programs that control costs and help consumers manage chronic conditions. AHIP is especially concerned that the policy would limit strategies to lower Americans' prescription drug costs.

AHIP was also critical of HHS' proposal to require issuers in states using Healthcare.gov to offer standardized plans at every service area, metal level and product type in which they offer non-standardized plans. This, the group said, "would stifle innovation and ignore health insurance providers' long-standing experience in designing benefits that meet employers' and consumers' needs." 

Aspects of the proposed standard plan designs that vary from common plan offerings, such as common prescription drug formulary designs, would be challenging for issuers to implement, and could be disruptive for consumers, AHIP said. It urged HHS to take an alternative approach of requiring issuers to offer only one silver-level standardized option in each service area in which they participate for plan year 2023, and publish enrollment data to assess whether standardized plan options meet consumer needs.

AHIP also opposes adopting what it called "blunt instruments" like limiting non-standard plans or active purchasing "that would harm competition, disrupt coverage for existing enrollees and stifle value-based insurance designs." As an alternative, AHIP supports reinstatement of prior meaningful difference standards to simplify the consumer shopping experience and make it easier to compare the differences between coverage options.

THE LARGER TREND

Though this is its first proposed payment rule, this is not the Biden administration's first marketplace rule. In June 2021, HHS and the Department of the Treasury finalized the third installment of the 2022 payment notice. That rule largely reversed the regulatory changes adopted in January 2021, such as allowing states to transition away from HealthCare.gov. 

Because those changes were already finalized, HHS had to undertake additional notice-and-comment rulemaking to undo them. The June 2021 rule also extended the duration of the annual open-enrollment period, eliminated the "double billing" rule for certain abortion services, and created a new monthly special enrollment period for low-income consumers.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com