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.
