Medicare Rights Offers Ways to Improve Affordable Care Act Regulations

The Medicare Rights Center recently submitted comments responding to a federal request for information titled “Patient Protection and Affordable Care Act: Reducing Regulatory Burdens and Improving Health Care Choices to Empower Patients.” The comments provide detailed suggestions about how the U.S. Department of Health and Human Services (HHS) can improve the Patient Protection and Affordable Care Act (ACA) regulatory landscape to empower patients and promote choice; stabilize the individual, small group, and other health insurance markets; enhance affordability; and affirm the traditional regulatory authority of the states.

Medicare Rights is encouraged by the request for public feedback, and urges HHS and the Centers for Medicare & Medicaid Services (CMS) to work collaboratively with diverse stakeholders, solicit broad input, and act responsively to the concerns of patients, consumer advocates, health care providers, and insurers as the agencies seek to improve the health care market through regulatory reform.

A recent example of this constructive collaboration involves the establishment of notices sent to people who have both Medicare Part A and a Marketplace plan. These notices serve several essential and sorely needed functions, including informing individuals of the need to enroll in Medicare, telling people that they are not eligible for tax subsidies for their Marketplace plan if they also have Medicare Part A, and directing them to personalized, unbiased assistance.

Responding to four areas of comment, Medicare Rights highlights ways federal agencies can work together with insurers, health care providers, and advocates. These include:

1. Empowering patients and promoting consumer choice: Medicare Rights recommends improving provider directories; protecting patients from “surprise bills”; promoting continuity of care; supporting navigator programs and consumer assistance; and reducing consumer confusion and facilitating access to plans that meet care, treatment, and affordability needs.

2. Stabilizing the individual, small group, and non-traditional health insurance markets: Medicare Rights recommends continuing cost-sharing reductions; enforcing the individual shared responsibility payment (ISRP); extending open enrollment; easing restrictions on special enrollment periods (SEPs); and limiting the availability of limited benefit and short-term coverage plans.
3. Enhancing affordability: Medicare Rights recommends discouraging the use of high co-insurance and high deductible health plans by issuers in the Marketplace; ensuring coverage of essential health benefits for all enrollees; and enforcing Section 1557, the nondiscrimination protection of the ACA.

4. Affiring the traditional regulatory authority of the States: Medicare Rights recommends continuing to develop templates and tools for use by state insurance regulators to assess compliance with federal rules; working with states to ensure adequate monitoring and enforcement of network adequacy requirements; and opposing the sale of insurance across state lines.

Read the Medicare Rights’ comments.