Major Insurer Groups Oppose ACA Signup Period Extensions

In recent comments submitted to CMS, the two major insurer trade groups — who thus far have mostly been on the same page as the Biden administration — object to proposals that would lengthen the annual enrollment window for Affordable Care Act exchange plans and add a new, monthly signup period for low-income individuals.

Underpinning the trade groups’ objections are concerns about adverse selection, which occurs when people wait until they’re sick or otherwise need costly health care services to purchase insurance. Similar to practices in the employer-sponsored insurance world and Medicare, the ACA marketplaces curb adverse selection by limiting enrollment to an annual signup window known as the open enrollment period (OEP). To sign up during a midyear special enrollment period (SEP), people generally need to have experienced a qualifying life event such as a job loss or marriage.

The rules surrounding the ACA exchange market’s OEPs and SEPs, however, are neither uniform nor static. The majority of states use the federal platform, HealthCare.gov, and therefore share the same annual signup window, but it has changed over the years. The first OEP in 2014 lasted 180 days, and the OEPs in 2015 through 2017 lasted 90 days, attorney and health care policy researcher Katie Keith noted in a recent Health Affairs blog post. Starting in 2018, the Trump administration shortened the OEP to 45 days — Nov. 1 to Dec. 15 — but in a draft rule issued in June, the Biden administration proposed to lengthen the OEP to 75 days: Nov. 1 to Jan. 31. That would apply to both HealthCare.gov and state-based exchanges, but as Keith points out, most SBEs already have extended their OEPs through January.

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