On March 19, the Trump administration published the proposed Marketplace Integrity and Affordability rule, which makes numerous changes to rules governing the Affordable Care Act Marketplaces. Writing in his personal capacity along with colleagues at the Georgetown University Center for Health Insurance Reforms and the Brookings Institution Center on Health Policy, Levitis lays out concerns about the rule and provides legal and policy analysis of the proposal.

The rule includes proposals to (1) reduce affordability and benefits, (2) add paperwork burdens and make it harder to enroll, and (3) narrow eligibility for coverage. The Centers for Medicare & Medicaid Services (CMS) attempts to justify its proposals as “program integrity” measures aimed at addressing “improper enrollment.” The comment letter authors argue that CMS’s estimates of the scope of the issue are deeply flawed, and even if correct, bear no reasonable relationship to the proposed changes. The rule does nothing to address the well-documented problem of unauthorized enrollments by brokers while imposing substantial burdens on eligible consumers. Finally, the proposed rule violates the law in several respects, for example by impermissibly narrowing the definition of “essential health benefits.”