Proposed Rule on ACA Heralds Advocacy Win for AAFP

Titled “Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond,” the proposed rule would broaden ACA enrollment opportunities while setting aside regulatory changes undermining access to comprehensive plans, to which the Academy strongly objected when they were announced by the previous administration.

The move follows the U.S. Supreme Court’s June 17 ruling upholding the ACA for a third time — preventing health care system “havoc” that the Academy and other amicus curiae warned would result if the law were struck down.

If finalized, the proposed rule would reflect recent Academy advocacy and improve access to comprehensive health coverage by

• extending ACA open enrollment to Jan. 15 of each year (beginning with the 2022 coverage year);
• adding a monthly special enrollment period for low-income individuals;
• removing the “exchange direct enrollment” process, by which states could replace centralized single health insurance exchanges with private-sector entities likely to “erode affordable access to primary care;”
• repealing Section 1332 waiver regulations that increased the availability of non-ACA-compliant health care coverage and undermined Medicaid; and
• reinstating comprehensive ACA navigator services.

The new monthly SEP would be especially important for low-income patients who might lose Medicaid coverage after the public health emergency ends as well as postpartum women, who often lose Medicaid coverage just six weeks after delivery. (The Academy continues to push for more robust postpartum coverage nationwide.) The SEP would provide additional opportunities for these patients to access subsidized, affordable health coverage.

Following recent special enrollment periods opened in response to COVID-19, ACA participation reached a record high this spring, CMS announced on June 5.