The Centers for Medicare and Medicaid Services (CMS) is seeking input on how it can reduce the economic and regulatory burdens of the Affordable Care Act (ACA). The request for information (RFI), published June 12 in the Federal Register (82 Fed. Reg. 26885), calls for recommendations on streamlining the ACA’s regulation of the individual and small-group markets, and eliminating problematic rules.

“We are looking for valuable feedback on how to change existing regulations in ways that put patients first, promote greater consumer choice, enhance affordability and return more control over healthcare to the States,” said CMS Administrator Seema Verma in a June 8 press release. “Through this step, CMS is asking consumers to send us innovative ideas that will help stabilize and strengthen the individual and small group health insurance markets.”

In January, President Trump issued an Executive Order directing federal agencies to provide flexibility and relief from ACA burdens to the greatest extent legally permitted, and foster a free interstate market for health care and health insurance.

As a result, the U.S. Department of Health and Human Services (HHS) directed CMS and its other divisions to revisit their ACA regulations “to determine whether each rule advances or impedes HHS priorities of stabilizing the individual and small group health insurance markets; empowering patients and promoting consumer choice; enhancing affordability; and returning regulatory authority to the States,” according to the RFI.

In April, CMS issued a final market stabilization rule designed to improve the healthcare marketplace and promote stability. The rule tweaked the enrollment process to reduce adverse selection and gave insurers more flexibility over their plans’ actuarial value. In May, the agency announced a plan to change the way small businesses enroll in insurance coverage through the federal exchanges.

In the RFI, CMS now is asking about other possible changes to rules or guidance that could further the following goals in the individual and small-group markets:

1. Empowering patients and promoting consumer choice. What activities would best inform consumers and help them choose a plan that best meets their needs? Which regulations currently reduce consumer choices of how to finance their health care and health insurance needs, including which insurer or provider to use?
2. Stabilizing the individual, small group, and non-traditional health insurance markets.What changes would bring stability to the risk pool, promote continuous coverage, increase the number of younger and healthier consumers purchasing plans, reduce uncertainty and volatility, and encourage uninsured individuals to buy coverage?
3. Enhancing affordability. What steps can HHS take to enhance the affordability of coverage for individual consumers and small businesses?
4. Affirming the traditional regulatory authority of states in regulating the business of health insurance.Which HHS regulations or policies have impeded or unnecessarily interfered with states’ primary role in regulating the health insurance markets?

The RFI is being issued only for information and planning purposes, CMS noted, and is not a notice of proposed rulemaking. The agency is asking for public comments to be submitted by July 12.