Academy Objects to Proposed Rewiring of ACA Enrollment

If finalized, the AAFP warned in a Dec. 23 letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma, M.P.H., the rule would increase the number of uninsured Americans and worsen health outcomes. The letter was signed by Board Chair Gary LeRoy, M.D., of Dayton, Ohio.

The ACA’s introduction of the individual market, the Academy wrote, “has improved access to the affordable, comprehensive and continuous primary care services that family physicians provide,” making it a success to be built upon, in keeping with AAFP principles.

The 2022 notice of benefit and payment parameters, published Dec. 4 in the Federal Register, threatens to undo that progress by letting states leave HealthCare.gov (or their own state-run versions) in favor of enrollment websites run by third-party entities such as insurers, agents and brokers.

“Allowing states to opt out of HealthCare.gov or eliminate their own exchange portals will complicate enrollment processes and increase burden on consumers, ultimately resulting in loss of coverage,” the letter said, expressing the Academy’s deep concern “that this proposal will increase the number of uninsured individuals across the nation, erode affordable access to primary care and negatively impact health outcomes.”

“This proposal will also create barriers to Medicaid and Children’s Health Insurance Program enrollment, and therefore result in an increase in uninsured individuals,” the AAFP wrote. “Data suggest that Medicaid coverage directly correlates with access to primary care: Children and adults covered by Medicaid are much more likely to have a usual source of care than their uninsured or privately insured low-income counterparts.”

Under current law, HealthCare.gov and state exchanges notify consumers if they are eligible for Medicaid and facilitate enrollment in Medicaid and CHIP. Private entities, however, have different incentives and lack consumer protections. Web brokers, for instance, “often fail to notify individuals that they are eligible for Medicaid or CHIP and will instead direct them to select a private plan,” the letter said.

“Relying solely on insurers and brokers will lead to less comprehensive coverage, raise premiums and reduce competition in the individual market as consumers are steered away from qualified health plans,” the AAFP added, noting that, under current regulations, one in four marketplace enrollees who sought help from a broker or insurer reported having been offered a non-ACA-compliant plan as an alternative to marketplace coverage.

“This proposal will expose more consumers to catastrophically high out-of-pocket costs as well as misleading and deceptive practices,” the letter said, because the rule would drive low-income individuals who are ineligible for Medicaid but eligible for premium assistance to short-term plans and other inadequate coverage to which the Academy has long objected.

“The AAFP strongly opposes this proposal and urges HHS not to finalize it,” the letter said.