You can tell the new secretary at the Department of Health and Human Services (HHS) is on the job. Sworn in hours after he was confirmed by the Senate on Friday, February 10, Doctor Tom Price began his first full day at HHS on Monday. By Wednesday, a new proposed rule was released that will help to stabilize the current individual marketplace that has been ravaged under the Patient Protection and Affordable Care Act (ACA), more commonly referred to as Obamacare. Congressional Republicans praised the rule as a way to shore up and provide relief to consumers within the individual market. 

The HHS secretary has been given a lot of discretionary power within the ACA. Secretary Price will take advantage of this power to change Obamacare and make it less onerous. One way to think of this rule is it helps to create a smooth glide path away from Obamacare while Congress and the Trump administration work to put the finishing touches on a replacement plan and strategize on repealing ACA through the budgetary process known as reconciliation.

The proposed rule is on a fast track as it only has a twenty-day comment period, which ends March 7, 2017, at 5 PM.  Major features in the rule include limiting the open enrollment time from November 1, 2017 to December 15, 2017 and a tightened eligibility process.

One of the problems under the Obama administration was its lackadaisical approach in allowing individuals to apply or re-enroll for health insurance outside of the open enrollment period. This lenient approach encouraged individuals to “game” the system.

The Obama administration permitted people to take advantage of special enrollment periods, such as a life-changing episode. Often people would wait until they needed to have a medical procedure or became ill, signed up for insurance, got the care they needed and then they would drop out of their insurance coverage after running up an expensive bill. These actions helped to destabilize the market. The administration routinely did not do any kind of vetting to see if the consumer was actually eligible to particpate in a special enrollment period. Others would abuse the three-month grace period where they could still receive coverage but not pay their premiums. The new rule calls for stricter verification on whether someone is eligible to sign-up outside the regular open enrollment window and insurers will be able to refuse coverage to persons until they pay any premiums that are owed.

The rule will also give greater flexibility to insurers in designing plans so they can provide more coverage options to patients.

One issue that was not addressed in the rule, which insurers had hoped for, was enforcing the individual mandate. But this is no surprise. Republicans loathe the individual mandate and will likely reduce the fine to $0.00 for not purchasing health insurance in the upcoming repeal bill.

Just prior to the announcement of this new HHS rule, a February 14, 2017 Reason Magazine article noted that the Internal Revenue Service (IRS) quietly released a new rule earlier in the month that would allow taxpayers to submit their tax returns without filling out line 61 on the 1040 tax form. This line requires individuals to indicate their health insurance coverage status. In the immediate past, if this line was empty, the IRS would not accept the tax return. According to Reason, the IRS stated it was issuing its new rule as a result of President Trump’s January 20, 2017 Executive Order, “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.” The IRS action and the HHS proposed rule are designed to work with one another in lightening the Obamacare burden.

This is a good start to a coordinated approach between the Trump administration and Congressional Republicans to repeal and replace Obamacare.