The Affordable Care Act seems to always be in a policy tug-of-war as its backers and critics spar over how it should work and who can qualify for coverage. This year is no different, with the Trump administration embracing standards it says will reduce fraud as well as steps that could further erode national enrollment.<\/p>\n
Wide-ranging ACA changes pushed by the administration were finalized in mid-May<\/a>, including new offerings such as plans with 30% higher out-of-pocket costs, and others with no set networks of doctors and hospitals.<\/p>\n The administration says such plans expand consumers\u2019 choices and may carry lower premiums.<\/p>\n The rule stated, though, that the combined effect of the new provisions could not only cost $1.3 billion each year to implement<\/a>, but also reduce enrollment by up to an additional 2 million next year. That would come on top of already anticipated sign-up decreases<\/a> this year because of higher premiums and smaller subsidy payments.<\/p>\n Over time, lower enrollment can boost premiums<\/a> if insurers suspect their costs are rising because healthier people drop coverage more than sicker members do.<\/p>\n Some policy experts fear the changes will erode the ACA and make it more expensive, particularly for those whose subsidies have shrunk or disappeared.<\/p>\n \u201cEven more people will lose coverage as healthcare costs and administrative burdens rise,\u201d said Katie Keith, director of the Center for Health Policy and the Law at the Georgetown University Law Center, who writes frequently<\/a> on changes to the ACA. \u201cAll of this comes at a time when millions of consumers are already experiencing a healthcare affordability crisis.\u201d<\/p>\n The lengthy payment rule is an annual exercise in which the Centers for Medicare & Medicaid Services, which oversees the ACA, can set new standards for coverage. The rule for next year is more ambitious than in past years, with changes to how plans are designed, eligibility verification, and adjustments needed to implement congressional legislation, along with technical updates.<\/p>\n Here are some of its biggest changes.<\/p>\n Non-Network Plans<\/strong><\/p>\n Starting in 2028, some Affordable Care Act consumers may be able to pick plans that don\u2019t have dedicated networks of doctors and hospitals, which patients use to qualify for negotiated in-network payment rates.<\/p>\n Under this new model, enrollees would seek out providers willing to accept the amount their insurer will pay toward whatever nonemergency care they need, such as a sore throat, a doctor visit, or childbirth.<\/p>\n The rule requires insurers to have \u201ca sufficient choice of providers that accept the non-network plan\u2019s benefit amount as payment in full.\u201d<\/p>\n Regulators say the policy aims to reduce costs<\/a> by getting consumers to \u201cshop for lower prices and negotiate directly with providers.\u201d<\/p>\n![\"Newsletter](\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\"){kind=icon}
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