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Life Health > Health Insurance > Your Practice

5 Top Affordable Care Act Fixer Comments From Producers

By Allison Bell

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Officials at the Centers for Medicare and Medicaid Services are now plowing through more than 3,000 comments from members of the public ideas who think they have good ways to improve Affordable Care Act health insurance rules and programs.  

CMS is the arm of the U.S. Department of Health and Human Services in charge of managing Affordable Care Act insurance rules and programs. Seema Verma, the CMS administrator, put out a request for ideas for improving the current health insurance framework in June. The comment period ended Wednesday.

(Related: Trump’s Health Chief Asks for Affordable Care Act Repair Ideas)

Members of Congress are trying to change the Affordable Care Act. At this point, however, it’s not clear whether lawmakers can get enough votes to make big changes in the law. CMS, other federal agencies and Congress may have to turn to doing what they can to fix and improve the current system.

Many commenters sent in ideas that are really pleas for the government to give them more help, or ideas that would could lead to obvious new health insurance market stability problems, such as rules that would make the current loose enrollment rules even looser.

More than two dozen of the comments appear to be from agents, brokers, other types of benefits advisors, or producer groups.

Here’s a sampling of five ideas from producer and producer group comments. We found the comments by searching through all comments for the terms “agent” and “broker”; producers who failed to identify themselves as such in the text of their comments may not have showed up in our results.

We looked for comments that seemed as if they might be possible to implement without congressional action.

We are calling these “top comments” because they included interesting, concrete suggestions and came up near the top of our search results. Clearly, opinions about what the best suggestions might be are likely to vary.

You can find more comments here.


1. Set a national essential health benefits package standard.

CMS has been letting each state set its own Affordable Care Act essential health benefits package standard. Issuers are supposed to use the EHB package to show how much value their plans provide, and help consumers shop for coverage on an apples-to-apples basis.

Some of the big state-level fights have been over how plans should cover expensive services such as intensive therapy for children with autism.

Paul Dougherty, president of the National Association of Insurance and Financial Advisors, said in a comment letter that NAIFA thinks setting a national EHB package would be better than leaving package decisions up to states. A national standard “may incentivze states to reconsider state laws or regulations which impose costly benefit mandates and increase insurance premiums,” Dougherty writes.


2. Start HealthCare.gov agent training earlier.

CMS has been starting the open enrollment period at HealthCare.gov, the federal Affordable Care Act exchange enrollment and account administration system, Nov. 1.

Today, HealthCare.gov agent training starts in August.

HealthCare.gov (Image: CMS)

(Image: Centers for Medicare and Medicaid Services)

Dougherty says training should start training and certification in June, because many producers are busy with group benefit plan renewals and preparations for the Medicare Advantage open enrollment period in August.


3. Require exchange plan issuers to pay agent and broker commissions.

California’s state-based Affordable Care Act exchange already sets minimum producer comp standards.

Jay Stuart, a Maryland broker, says setting producer comp standards for all states’ exchange programs would help purchasers of individual coverage get adequate consumer assistance.

4. Let group plans going through mid-year plan changes get Summary of Benefits and Coverage notices to enrollees 15 days in advance, rather than 60 days in advance.

An Affordable Care Act SBC notice is supposed to be like a milk carton nutrition label for health coverage. It’s supposed to give consumers and others a simple way to compare plans.

Larry Robinson, a Georgia insurance agent, says requiring plans going through major mid-year changes to get SBCs to enrollees 60 days in advance is unrealistic.

Most plans going through material mid-year changes are doing so either because the employer is going through hard times or because an employer wants to help a sick employee get a better plan, Robinson says.

The enrollees usually can’t change coverage, anyway, because a material change in a group plan is not an event that qualifies people for Affordable Care Act individual major medical special enrollment period, so, getting the SBC notice just 15 days in advance would not change what the enrollees can do, Robinson says.

5. Change the Affordable Care Act premium tax credit subsidy income verification procedures.

Antonio Paulo Pinto, a health insurance consultant based in Farmington, Connecticut, says one change the Affordable Care Act program should be more realistic about what premium tax credit users are like.

Today, he says, a consumer who expects to earn about $30,000 in a year but has a pay stub showing just $2,000 in income for the latest month will run into income verification problems.

The current verification system “was based on the assumption that 80% of all U.S. taxpayers have less than a 10% variance in income year-over-year,” Pinto writes. “Ironically, no one thought to think, ‘Is that because those people have full-time jobs with benefits?’ The reality is that people needing to access subsidies are people with variable incomes, and the current verification system was not designed for them.”

— Read 4 ACA Change Paths That Just Got More Popular on ThinkAdvisor.

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