Managers of the Affordable Care Act public exchange system are trying to figure out what to do in 2017 for slow-acting consumers affected by health coverage issuer withdrawals.
Officials at the Center for Consumer Information & Insurance Oversight, the federal agency directly responsible for overseeing the HealthCare.gov exchange enrollment system, posted a batch of information about a process for helping stranded exchange plan enrollees late last month.
HealthCare.gov handles enrollment for states that are unable or unwilling to run their own ACA exchange enrollment systems. Early peeks at exchange participation applications for 2017 suggest that, in some states, 2017 menus could be much shorter than 2016 menus.
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Officials at the HealthCare.gov center — which is part of the Centers for Medicare & Medicaid Services, which, in turn, is part of the U.S. Department of Health and Human Services — say a state health insurance regulatory authority can set its own rules for helping stranded exchange plan users who fail to take steps to choose new health coverage.
If a state does not set its own rules, HealthCare.gov will start by trying to put a user stranded by the disappearance of an issuer’s plan in another plan from the same issuer, center officials say.
If the issuer does not offer any plans in the consumer’s area, then HealthCare.gov will try to enroll the consumer in a plan from another issuer with the same metal level and product network type, officials say.
Theodore Nickel, the Wisconsin insurance commissioner, says HealthCare.gov will have to use a different process in his state, because the HealthCare.gov center process violates the Wisconsin interpretation of its insurance laws and regulations.
For a look at some of the details from a letter Nickel sent to Kevin Counihan, director of the HealthCare.gov center, read on:
Ted Nickel (Photo: Wisconsin Office of the Governor)
1. Nickel says the HealthCare.gov center process could push some consumers to pay for health coverage chosen by the federal government.
Consumers are supposed to have the right to enter into insurance contracts free from external pressure. Automatically putting a consumer in an insurance plan may help the consumer stay covered, but it creates pressure, Nickel says.
Nickel questions whether the Center for Consumer Information & Insurance Oversight process for helping stranded exchange plan enrollees is legal. (Photo: John Kroetch/Thinkstock)
2. Nickel says the 2017 exchange auto-enrollment process violates both federal contract law principles as well as Wisconsin law.
He says the process the HealthCare.gov center intends to use for stranded enrollees in 2017 would violate the law whether the federal government moves consumers into a plan automatically or the federal government moves consumers into a plan automatically.
Nickel says the HealthCare.gov stranded-user process would amount to steering users toward some plans and away from others. (Image: Thinkstock)
3. Nickel says a government agency has no right to drive business to one coverage issuer over another.
Steering consumers toward particular plans would violate their freedom to contract, he says.
Related: Pennsylvania forgoes state exchange
Nickel says any HealthCare.gov workers involved with moving consumers from one plan to another should be insurance agents. (Photo: Thinkstock)
4. Nickel says anyone participating in the solicitation of health insurance must hold an agent license.
If HealthCare.gov employees or other federal employees who are not licensed to sell insurance in Wisconsin move stranded exchange plan enrollees from one plan to another, they would be violating state agent licensing laws, he says.
Nickel wonders how the HealthCare.gov plan switchers will avoid privacy problems. (Image: Thinkstock)
5. Nickel says the transfer of personal information needed to implement the auto re-enrollment process would violate Gramm-Leach-Bliley Act financial privacy requirements.
The Gramm-Leach-Bliley Act prohibits insurers and agents from releasing nonpublic personally identifiable information, and transferring consumer bank account information from one health coverage issuer to another without the consumers’ authorization could lead to consumers being debited for premiums for plans the consumers did not choose, Nickel says.
If exchange managers expect consumers to take active steps to start sending payments to the issuers of the replacement plans, that create significant consumer confusion, Nickel says.
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