Proposed Rule Could Make Healthcare Coverage More Affordable and Accessible for Consumers

The Biden administration recently released the Notice of Benefit and Payment Parameters 2023 Proposed Rule that is designed to make health insurance coverage more accessible and affordable in 2023. “Today’s rule is part of the Biden-Harris Administration’s ongoing efforts to ensure an equitable health care system as we continue to make coverage more accessible and affordable,” said Health and Human Services Secretary Xavier Becerra in a press release. The proposed rule also supports the Executive Order on Promoting Competition in the American Economy, which emphasizes affordable health insurance. This is the Biden administration’s first full notice and generally applies to changes for the 2023 plan year, not 2022.

The goal of the proposed rule is to improve shopping for healthcare coverage, establish rules ensuring the public can access care, and advance health equity for individuals purchasing coverage on the ACA marketplaces.

All insurance companies selling coverage on the federal healthcare.gov exchange and on the state-based exchanges would be required to provide standardized plan options for every product network type, metal type, and plan classification in addition to any service area where the issuer will provide marketplace plans.

CMS also proposes to implement network adequacy rules, which would include important features such as distance to care and appointment wait times. Additionally, the proposed rule will help to provide healthcare for low-income and medically underserved consumers, specifically through essential community providers (ECPs). Insurers would be required to include 35% of available ECPs in their network for each plan’s service area. The proposed rule would also include substance use disorder treatment centers as eligible ECPs, partly in response to the opioid epidemic. In November 2021, the CDC released provisional data showing an estimated 100,306 death from drug doses in the 12-month period ending in April 2021, an increase of 28.5% from the April 2019-April 2020 time period. The same announcement said that 75,673 of those deaths were from opioids, an increase of 35% from the year before

The proposed rule will also prohibit health insurance companies from discriminating based on sexual orientation and gender identity and will restore protection for covered services that were previously removed in 2020 to reduce healthcare disparities and increase access to care. Health insurance companies must also rely on evidence-based medicine for making clinical decisions as part of the plan design under the proposed rule requirements.

Katie Keith, J.D., M.P.H., who writes “Following the ACA” analyses for the Health Affairs’ Forefront blog, has posted three in-depth pieces about the rule. Full text access it free and available here. Keith is the director of the Health Policy and the Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center.