News: CMS Marketplace Integrity and Affordability final rule receives AHA criticism
CMS announced it is finalizing its 2025 Marketplace Integrity and Affordability final rule, according to the American Hospital Association (AHA).
According to a CMS fact sheet, the final rule contains a number of critical modifications and regulatory statutes pertaining to the Affordable Care Act (ACA), such as:
- Repealing the special enrollment period (SEP) for enrollees with “projected household incomes at or below 150% of the federal poverty level”
- Requiring income verifications for those receiving subsidiaries and conducting “the majority of enrollments” through SEPs
- Reducing advanced payment of the premium tax credit (APTC) by $5 a month for those “re-enrolled in fully-subsidized plans without eligibility verification”
- Prohibiting “federal subsidies from being used to help cover the cost of specified sex-trait modification procedures to align an individual’s physical appearance or body with an asserted identity that differs from the individual’s sex”
The proposed final rule has received stern criticism from the AHA, which argued that the proposed changes will “create barriers for truly eligible marketplace consumers without sufficient focus on the agents and brokers instigating [inappropriate] enrollments.”
More globally, the AHA estimated that the loss of coverage will have “substantial consequences for patient access to care, as well as the financial stability of hospitals, health systems, and other providers.”
Editor’s note: To read the CMS fact sheet, click here. To read the AHA letter of concern, click here.