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ACA change rules

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Members of the 115th Congress started off their term by establishing rules for their own operations, and for how they will go about considering proposals for repealing and changing “Obamacare.”

Many critics of “Obamacare” have been vague about what exactly they mean when they refer to “Obamacare.”

Some people use “Obamacare” to include both of the laws included in the two-law Affordable Care Act package, including many provisions which have no direct relationship with health insurance, such as programs for helping would-be doctors, nurses and medical assistants pay for their education.

Other “Obamacare” critics seem to use the word to refer only to the ACA commercial health insurance rules and mandates, the ACA public exchange system, and, possibly, the ACA Medicaid expansion program.

In one section of the House operating rules package, House leaders set a special budget impact rule for consideration of any measure that would repeal or change the Patient Protection and Affordable Care Act of 2010, or the Health Care and Education Affordability Reconciliation Act of 2010.

Related: House rules package eases ACA change fight

I think it would be great if congressional leaders could add some health insurer stabilization provisions.

Certainly, everyone loves to beat up on health insurers, but I don’t think accidentally making all of the Blue Cross and Blue Shield carriers fall over like a bunch of dominos, or even just forcing them all out of the individual major medical market lickety-split, would turn out to be very popular.

Here are some ideas for transitional stabilization rules:

        • The top 2017 officers of the National Association of Insurance Commissioners happen to be Republicans. Maybe any major ACA repeal or change legislation could include a provision encouraging the U.S. Health and Human Services secretary to work with the NAIC to set transitional rules to keep the individual major medical market alive while the shift to the new rules is under way. Or, if populist Republicans are wary of NAIC involvement, at least appoint some fierce budget hawk who is no great friend of health insurers to protect insurers against severe, regulatory-driven threats to their solvency, or to the financial stability of what’s left of the individual major medical market.

        • Decide now to reeze the rules and subsidies for 2017 and for 2018 in place. Pulling the rug out from everyone in the middle of this year would be mean, and insurers are already designing their product menus for 2018. Insurers deserve to be able to shift to a new system gradually.

        • Let health insurers adjust their rates and benefits every three months during the two-year period after any major new rules take effect. Right now, one huge source of market instability is a rigid health coverage pricing system that forces insurers to use old claim data, from periods of time governed by different rules, to set their rates for the coming year. In some cases, insurers may leave markets simply to avoid being locked into sticking with unrealistically low rates.

If insurers could adjust rates in response to new information about how new rules really work, maybe they’d be more comfortable with holding initial rates down, and more comfortable with staying in markets affected by dramatic regulatory changes.

Allison Bell is a senior editor at 


2017 health, disability and LTCI planner

GOP readies swift Obamacare repeal with no replacement in place

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