New controls on Obamacare planned for 2027
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The Trump administration on Monday proposed tightening marketing standards and adding income verification policies for Affordable Care Act marketplace plans starting in 2027.
Why it matters: The proposal would expand how plans can operate in the marketplace, which regulators say could reduce fraud and lower premiums.
- But it may also make coverage harder to obtain for some low-income enrollees and steer more consumers toward high-deductible plans.
State of play: The Centers for Medicare and Medicaid Services would extend a requirement that enrollees submit documents to verify their income when they have low earnings, or when tax data isn't available.
- Federal administrators also outlined specific conduct that would be prohibited by agents and brokers, including falsely claiming that consumers could qualify for "zero-dollar" insurance and using AI to create fake endorsements.
- The rule also would for the first time measure improper payments of advance premium tax credits administered by state-based marketplaces.
"We are cracking down on improper and misleading practices while giving states and health plans more room to innovate and compete. The goal is simple: lower costs, more choice, and Exchanges that work as intended," CMS administrator Mehmet Oz said in a statement.
Between the lines: The 577-page proposal would also make it easier for people to enroll in catastrophic coverage. These plans have low monthly premiums but very high deductibles.
- CMS previously expanded access to the plans in September.
The intrigue: CMS wants to let plans without any provider networks be sold on the Obamacare marketplaces, if they can ensure access to enough providers that accept their benefit amount as payment.
- CMS says in a fact sheet that this could reduce "substantial administrative overhead associated with traditional network management, potentially resulting in lower premiums."
Zoom out: CMS also wants to make it easier for states to operate their own health insurance exchanges for Obamacare coverage, and it proposed repealing a Biden-era policy that would have made dental care more available to adults with ACA coverage.
- The public can submit comments on the proposal through March 11.
