While an Affordable Care Act repeal is imminent, any major changes to the law will be at least a couple years off as Republicans work out a feasible plan. But there are some easy things they can do right away to close loopholes that are costing taxpayers, insurance companies, and the health care system overall.
One of those is special enrollment periods, which allows people to sign up for health care within 60 days of a major life event including, losing health coverage, moving, getting married, having a baby, or adopting a child.
Experts say some people are abusing those options to enroll.
"Allowing people to sign up for coverage, pretty much when they feel like they need services, that's a disaster. So we need to validate that people actually qualify for the special enrollment period,” said John Cerisano, the BlueCross BlueShield Association federal relations vice president.
Another area of waste and abuse is people taking advantage of grace periods. Before the ACA, insurers could cancel policies after 30 days of non-payment. Now, insurers must wait 90 days.
"After the 90-day grace period, an individual can resign back up for coverage, even with the same carrier, and the carrier is not able to go back and recoup those passed due premiums. That's something that can be taken care of relatively quickly,” Cerisano said.
Experts say it is also possible that the individual mandate could be eliminated relatively quickly too - but not in the way you might expect.
"I think they're going to re-brand the mandate. I think they're going to call it something else. I think this would be very easy to do. Instead of guaranteed issue with all these special enrollment periods, you change that to guaranteed renewability. And you portray that as, 'See what we have given you. You've taken personal responsibility to get insurance, and once you have insurance, they can't cancel you for preexisting conditions,'" said Dr. Nancy Nielsen, M.D., Ph.D.,UB senior associate dean for health policy.
The individual mandate concept was instituted in Massachusetts under Republican Governor Mitt Romney before President Obama's Affordable Care Act. And the mandate was branded as an individual responsibility. Those who did not buy health insurance had to pay a penalty. A sliding "affordability scale" determined whether a person had to pay that fine.