Insurers spoke, and the president listened. At least with oneear. And so, the special enrollment periods for exchange healthinsurance have been tightened a bit.

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As his administration winds down, President Obama has continuedto tinker with the recipe for the Patient Protection and AffordableCare Act. Large insurers have been complaining loudly about thespecial enrollment periods created by PPACA, saying they encouragepeople to sign on for affordable insurance when they’re facing bigmedical bills. That gouges the insurers by throwing off the balanceneeded in an insured group, resulting in high claims and low, orno, profits for the insurers.

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This “gaming” of the health care exchange network has majorinsurers threatening to drop their exchange business. So last week,bowing to the pressure, the Centers for Medicare and MedicaidServices finally responded to the cries for help.

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It wasn’t a full-on repeal of the special enrollment periods,but it does offer some relief to insurers. Henceforth, individualswho claim a new home address and seek to purchase coverage duringan extra sign-up slot must have proof that, within the previous 60days, they had health insurance. Not only would that cut down onthe late sign-ups by those who have been uninsured, but it shouldboost enrollment during the traditional period.

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While tightening the enrollment loopholes, CMS is also addingrestrictions to its “six reasons” that consumers can cite forseeking special enrollment periodinsurance.

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The six — losing other health coverage, household size changesdue to marriage or birth, a new home, the need for cheapercoverage, errors made by marketplaces or plans, and cases ofcycling between types of insurance — underwent redefinitionsdesigned to make the bar higher for eligibility.

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The new rules took pity on another party, the co-ops, which have been hammeredby the late-period enrollments and subsequent claims. Half of themfailed soon after the claims started to pour in. They werelaunched in an atmosphere of want, since Republicans, who opposedthe subsidized co-ops, refused to fully budget them.

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Now, says CMS, they can strike strategic partnerships “withother entities” to bolster their finances.

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“In the absence of additional federal loans to co-ops, many ofthese entities would benefit from the infusion of private capitalto assist them in achieving long-term stability and competitivesuccess in the market,” the CMS said in the rule.

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.