Managers of HealthCare.gov are acting on theassumption that the Affordable Care Act public exchange system willstill be selling individual and small-group health insurance coverage in 2019.

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The agency that runs HealthCare.gov posted a draft letter to 2019 HealthCare.gov planissuers Monday.

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The agency, the Center for Consumer Information and InsuranceOversight (CCIIO), also posted a draft description of the health plan ratefiling deadlines for 2019 individual and small-group plans, and aproposed 2018 filing deadline summary sheet.

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HealthCare.gov should continue to work pretty much the same wayin 2019, officials say.

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If the draft schedule is correct:

  • Issuers will apply to sell 2019 plans from May 9, 2018, throughJune 20, 2018.

  • The 2019 plan rates will be due July 25, 2018.

  • The 2019 rates will go live on the RateReview.HealthCare.govwebsite Aug. 1, 2018.

  • The open enrollment period for 2019 individual major medicalplans will start Nov. 1, 2018.

In several places in the draft letter for 2019, officialssuggest that readers can get more information by looking in the2018 letter.

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Samara Lorenz, the director of the CCIIO oversight group, islisted as the author of the draft description of the rate filingdeadlines for the 2019 plans. She has also taken responsibility forsending out similar notices for CCIIO since at least 2015.

President Trump

President Donald Trump has proposed repealing and replacing theAffordable Care Act, but he has not talked directly about thefuture of the ACA public exchange system.

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Many of the Republican proposals for changing or replacing thecurrent ACA major medical insurance rules and programs would leavethe exchange system in place.

The Affordable Care Act: A brief history

The ACA created a system of "health insurance exchange"programs, or web-based health insurance supermarkets, in an effortto make buying individual and small-group commercial healthinsurance as easy as buying a book from Amazon.com.

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Continued on next page >>>

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Exchange programs began selling coverage Oct. 1, 2013, and thefirst policies sold took effect Jan. 1, 2014.

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Drafters of the ACA assumed most states would run their ownexchange programs.

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The U.S. Department of Health and Human Services (HHS) set upHealthCare.gov to provide ACA exchange plan enrollment and accountadministration services for states that were unwilling or unable toset up their own ACA exchange programs. HealthCare.gov now runs orsupports the public exchange programs for 39 states.

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The Centers for Medicare and Medicaid Services (CMS) is the HHSdivision in charge of HealthCare.gov and other ACA rules andprograms that affect the commercial health insurance market.

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CMS set up CCIIO to take charge of running the ACA commercialhealth insurance programs and enforcing the ACA commercial healthinsurance rules.

Proposed 2019 changes

CCIIO says it will probably eliminate the current effort torequire that any new HealthCare.gov plans introduced in amarket be meaningfully different from other plans already availablein the same market.

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Some health policy watchers say offering too many choices canconfuse consumers, but CMS officials argued in a draft 2019parameters notice that HealthCare.gov is now suffering from havingtoo few choices in many markets, not too many choices.

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CCIIO also wants to change the threshold it uses to determinewhen a health plan issuer must explain a premium increase.

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In the past, issuers had to explain any increase 10%. Startingin 2019, CCIIO may increase the increase explanation threshold to15%.

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CCIIO says it will also try to make life easier for the webbrokers that want to help customers apply directly for AffordableCare Act advance premium tax credit subsidies when buying exchangeplans, and to make life easier for the agents and brokers that usethe web brokers' direct enrollment systems.

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CCIIO will let the web brokers choose the outside entities thatdecide whether the agents and brokers are qualified to use thedirect enrollment process, officials say.

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Letting an outside entity decide whether producers are ready touse the direct enrollment system should reduce the regulatoryburden on those producers, officials say.

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Allison Bell

Allison Bell, ThinkAdvisor's insurance editor, previously was LifeHealthPro's health insurance editor. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached at [email protected] or on Twitter at @Think_Allison.