Opposing Marketplace Integrity Rule That Will Result in Millions Losing Health Insurance

ACS CAN has joined two amicus briefs in litigation challenging the Marketplace Integrity and Affordability Rule finalized in June by the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) that will result in millions of people losing health insurance coverage under the Affordable Care Act (ACA).  The rule revises standards relating to denial of coverage for failure to pay past-due premium; excludes Deferred Action for Childhood Arrivals recipients from the definition of “lawfully present;” revises the Exchange automatic reenrollment hierarchy; revises standards related to the annual open enrollment period and special enrollment periods; revises standards relating to failure to file and reconcile, income eligibility verifications for premium tax credits and cost-sharing reductions, annual eligibility redeterminations, de minimis thresholds for the actuarial value for plans subject to essential health benefits (EHB) requirements, and income-based cost-sharing reduction plan variations. The rule also revises the premium adjustment percentage methodology and prohibits issuers of coverage subject to EHB requirements from providing coverage for specified sex-trait modification procedures as an EHB.

By CMS’s own estimate, these technical changes will result in at least 1.8 million individuals losing health insurance coverages. 

The rule was scheduled to go into effect August 25.

On July 17, 21 states led by California filed a lawsuit in Massachusetts seeking to invalidate the rule in California et al v. Kennedy.  In the complaint, the attorneys general (AGs) argue that the rule is arbitrary and capricious, contrary to law, and violates the Administrative Procedure Act (APA). The coalition is seeking a preliminary injunction and a stay to prevent the challenged portions of the final rule from taking effect in the Plaintiff States before the August 25 effective date, and for the court to vacate the rule.

ACS CAN joined an amicus brief filed in late July supporting the lawsuit, providing the court with background on the ACA, scientific studies demonstrating that comprehensive and affordable health insurance saves lives, and examples of real people adversely affected by the rule.  In early September, ACS CAN joined a similar amicus brief filed at the US Court of Appeals for the Fourth Circuit in a parallel  lawsuit brought by localities, City of Columbus v. Kennedy.  Fortunately, the district court in that case put some of the most problematic elements of the rule on hold while the litigation is pending.