The Association for Community Affiliated Plans (ACAP) thanks you for considering our concerns regarding a recent change in the interpretation of section 1201 of the Patient Protection and Affordable Care Act (ACA), as represented in Exchange and Insurance Market Standards for 2015 and Beyond; Proposed Rule released March 2014 and the final Exchange and Insurance Market Standards for 2015 and Beyond, released May 16, 2014.
ACAP is an association of 57 not-for-profit and community-based Safety Net Health Plans (SNHPs) located in 24 states. Our member plans provide coverage to approximately 10 million individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP) and Medicare Special Needs Plans for dually-eligible individuals. Nationally, ACAP plans serve roughly one-third of all Medicaid managed care enrollees. Sixteen of ACAP’s Safety Net Health Plan members have elected to participate in the Marketplaces in 2014.
We wish to bring to your attention the impact on Safety Net Health Plans of the recent reinterpretation of section 1201 of the ACA, which by way of section 2702 of the Public Health Service Act (PHSA) requires ―each health insurance issuer that offers health insurance coverage in the individual or group market in a state [to] accept every employer and individual in the state that applies for such coverage.‖ ACAP has been a consistent and strong supporter of the reforms enacted in the ACA; as Safety Net Health Plans committed to providing coverage to high-needs and often disenfranchised populations, we commend HHS’ efforts to ensure that all Americans have access to high-quality, consistent coverage and care. Nonetheless, because of the abrupt nature of this policy shift, we have heard that some Safety Net Plans are rethinking their participation in the Marketplaces given the risks and burdens the change will require. While we have had several generally helpful conversations with CCIIO staff about this issue, we seek assurances from CCIIO leadership that the agency both understands that the source of this conflict is inconsistencies in CCIIO’s own guidance and practice, and intends to ensure that issuers’ participation in the Marketplace is not jeopardized by the shift.