March 9, 2017: State Advocacy Update


The AMA provided comments (PDF) this week on CMS' proposed rule on market stabilization. While the proposed rule was identified by CMS as an effort to stabilize the individual and small group markets, the AMA expressed concerns about the negative impact the changes could have on patients and their physicians.

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For example, by significantly reducing the annual enrollment period and limiting special enrollment opportunities, the rule could lead to many individuals finding themselves without coverage. Likewise, proposals that would loosen network-adequacy requirements and reduce the percentage of essential community providers with whom payers must contract would undoubtedly hinder access to care for many of the most vulnerable patient populations.

Overall, the proposed rule has the potential to raise premiums, out-of-pocket costs or both for moderate-income families, and would make it more difficult for eligible individuals to enroll in health insurance coverage and access needed care.