ACS CAN Comments on Market Integrity Proposed Rule

ACS CAN supports the administration’s goal of improving market integrity and we are committed to policies that effectively address any waste, fraud, and abuse that exists in public health care programs. However, we are concerned the overall impact of this proposed rule will actually impede access to comprehensive health insurance coverage and create more gaps in coverage rather than address any potential waste in the program.

By CMS’ own estimates between 750,000 to 2 million fewer individuals would enroll in qualified health plan (QHP) coverage in 2026 if this proposal was finalized. These estimates do not account for other recent agency actions such as the significant cuts to navigator grant funding and the reduction of CMS personnel which are likely to result in decreased enrollment. Nor do CMS estimates account for the potential expiration of the enhanced Affordable Care Act (ACA) tax credits which have contributed to the record-breaking enrollment in Marketplace plans since they were enacted by Congress in 2021. ACS CAN is concerned that these cumulative policies will result in fewer individuals having access to affordable, comprehensive coverage.

ACS CAN's commented on the following provisions of the proposed rule:

• Limited Open Enrollment Periods (§ 147.104(b)(2))
• Coverage denials for failure to pay premiums for prior coverage (§ 147.104(i))
• Definitions: Deferred Action for Childhood Arrivals (§ 155.20)
• Verification Process Related to Income Eligibility for Insurance Affordability Programs (§§ 155.305, 155.315, and 155.320)
• Annual Eligibility Redetermination (§155.335)
• Annual Open Enrollment Period ( 155.410)
• Monthly SEP for APTC-Eligible Individuals with Incomes at or Below 150 Percent FPL (§ 155.420)
• Pre-enrollment Verification for Special Enrollment Period (§ 155.420(g))
• Prohibition on Coverage of Sex-trait Modification as an EHB (§ 156.115(d))
• Premium Adjustment Percentage (§ 156.130(e))
• Levels of Coverage – Actuarial Value (§§ 156.140, 156.200, 156.400)