In three and a half years, the Trump Administration has sabotaged, undermined, defunded, and attempted to legislatively and judicially repeal the Affordable Care Act. The latest round of sabotage comes under the guise of the Notice of Benefit and Payment Parameters (NBPP) proposed rule. The NBPP is an annual rule outlining requirements for federal and state marketplaces, as well as the Essential Health Benefits standards for most individual and small group plans for the upcoming plan year. HHS released the 2021 proposed NBPP in early February 2020, and comments are due March 2.
Two of the proposed changes that would have a direct impact on consumers focus on co-pay accumulators and auto-reenrollment.
Increased Co-Pays and Deductibles for Consumers
The high cost of prescription drugs hits lower-income people the hardest. That is why many patients rely on manufacturer’s coupons to help them with their co-pays. Coupons help people afford their share of the cost of prescription drugs, which can be as much as half of the price of the drug.
Health insurance companies and the administration want to make it more costly for patients who use coupons. The administration would let health insurance companies keep the coupons WITHOUT counting coupons (or other co-pay assistance) toward someone’s deductible and out-of-pocket maximum, even where there is no cheaper generic alternative. That means that consumers would pay more for their medicine out of their own pockets, and it will take them longer to meet their deductible and out-of-pocket maximum. People who need more expensive drugs may be faced with a bill for thousands of dollars to get the medicine they need when their coupons run out.
No Auto-reenrollment if a consumer’s premium is $0
According to the proposed rule, 1.8 million people were automatically reenrolled in coverage for 2019, including 270,000 people with $0 premiums.
Under current rules, if a consumer does not update their income during marketplace open enrollment, his health plan renews for the next year with the same tax credits. The Trump Administration wants to stop the automatic renewal if the enrollee’s premium would be $0. If a consumer doesn’t update his income and other financial information, they would have to pay a premium to enroll. HHS proposes to withhold some or all of their tax credits until the consumer updates their financial information.
HHS says it would conduct outreach about this new process and reach out to consumers affected by such a change. Yet many people do not know they should update their information during open enrollment and have been auto-reenrolling with $0 premiums for several years. The result is they may not renew their plan if they get a bill for the full amount (even if they could get a refund when they file their federal income taxes).
What else does the rule change?
The proposed rule also makes changes in other areas such as essential health benefits, special enrollment periods, and risk adjustment. It seeks comments on some issues regarding appeals and effective coverage dates. For more information on the other parts of the rule, see Sabrina Corlette’s summary and Katie Keith’s three-part series for Health Affairs – Part 1 (insurer provisions including plan benefits, eligibility, enrollment), Part 2 (exchange provisions) and Part 3 (risk adjustment).
Comments are due March 2, 2020, and can be submitted here. NHeLP has also launched a comment “portal” where individuals who may be impacted by these provisions can get more information and submit their comments.