The Trump administration just proposed massive changes to Obamacare

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The Centers for Medicare and Medicaid Services announced new proposals for the Affordable Care Act's (ACA) individual insurance exchanges on Wednesday morning.

The proposals from CMS include a number of changes to enrollment periods and timelines for insurers in an attempt at "stabilizing the individual and small group health insurance markets," according to a press release.

The changes are the first administrative tweaks to the law also known as Obamacare under the new administration of President Donald Trump. They contain a combination of long considered ideas and some serious departures from the previous administration.

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Protests for and against Obamacare
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Protests for and against Obamacare

Tea Party Patriots supporters hold signs protesting the Affordable Care Act in front of the Supreme Court as the court hears arguments on the health care reform bill on Tuesday, March 27, 2012.

(Photo By Bill Clark/CQ Roll Call)

Affordable Care Act supporters wave signs outside the Supreme Court after the court upheld court's Obamacare on Thursday, June 25, 2015.

(Photo By Bill Clark/CQ Roll Call)

A man holds signs during a protest on the second day of oral arguments for the Patient Protection and Affordable Care Act in front of the U.S. Supreme Court building on March 27, 2012 in Washington, DC. Today is the second of three days the high court has set aside to hear six hours of arguments over the constitutionality President Barack Obama's Patient Protection and Affordable Care Act.

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Sister Caroline attends a rally with other supporters of religious freedom to praise the Supreme Court's decision in the Hobby Lobby, contraception coverage requirement case on June 30, 2014 in Chicago, Illinois. Oklahoma-based Hobby Lobby, which operates a chain of arts-and-craft stores, challenged the provision and the high court ruled 5-4 that requiring family-owned corporations to pay for insurance coverage for contraception under the Affordable Care Act violated a federal law protecting religious freedom.

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An Obamacare supporter counter protests a Tea Party rally in front of the U.S. Supreme Court in the morning hours of March 27, 2012 in Washington, DC. The Supreme Court continued to hear oral arguments on the Patient Protection and Affordable Care Act.

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Affordable Care Act supporters hold up signs outside the Supreme Court as they wait for the court's decision on Obamacare on Thursday, June 25, 2015.

(Photo By Bill Clark/CQ Roll Call)

Ron Kirby holds a sign while marching in protest of the Patient Protection and Affordable Care Act in front of the U.S. Supreme Court on March 26, 2012 in Washington, DC. Today the high court, which has set aside six hours over three days, will hear arguments over the constitutionality President Barack Obama's Patient Protection and Affordable Care Act.

(Photo by Mark Wilson/Getty Images)

A protester waves his bible in the air as he overpowered by cheers from supporters of the Affordable Care Act as they celebrate the opinion for health care outside of the Supreme Court in Washington,Thursday June 25, 2015. The Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama's health care overhaul, in a ruling that preserves health insurance for millions of Americans.

(Photo By Al Drago/CQ Roll Call)

Nuns, who are opposed to the Affordable Care Act's contraception mandate, and other supporters rally outside of the Supreme Court in Washington, D.C., U.S., on Wednesday, March 23, 2016. On Wednesday morning, the Supreme Court is scheduled to hear oral arguments in Zubik v. Burwell, a consolidated case brought by religious groups challenging a process for opting out of the Affordable Care Act's contraception mandate.

(Drew Angerer/Bloomberg via Getty Images)

Supporters of contraception rally before Zubik v. Burwell, an appeal brought by Christian groups demanding full exemption from the requirement to provide insurance covering contraception under the Affordable Care Act, is heard by the U.S. Supreme Court in Washington March 23, 2016.

(REUTERS/Joshua Roberts)

Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court heard a second challenge to US President Barack Obama's Affordable Care Act. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June.

(MANDEL NGAN/AFP/Getty Images)

 Linda Door (L) protests against President Obama's health care plan in front of the U.S. Supreme Court Building on March 26, 2012 in Washington, DC. Today the high court, which has set aside six hours over three days, will hear arguments over the constitutionality President Barack Obama's Patient Protection and Affordable Care Act.

(Photo by Mark Wilson/Getty Images)

Supporters of the Affordable Care Act celebrate after the Supreme Court up held the law in the 6-3 vote at the Supreme Court in Washington June 25, 2015. The U.S. Supreme Court on Thursday upheld the nationwide availability of tax subsidies that are crucial to the implementation of President Barack Obama's signature healthcare law, handing a major victory to the president.

(REUTERS/Joshua Roberts)

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Perhaps the two most striking changes are cutting in half the exchanges' 2018 open enrollment period and lowering minimum standards for care to qualify for the exchanges.

The new rules propose having an open enrollment period, during which people without health insurance through their employer of Medicaid/Medicare can sign up for coverage, from November 1, 2017 to December 15, 2017. Previously, open enrollment periods have run a total of three months from November 1 to January 31 of the next year.

Additionally, the rules would lower the "de minimis range used for determining the level of coverage." Essentially, the ACA established minimum standards for coverage (here's a full breakdown from CMS) in order to be certified on the bronze, silver, and gold plan levels. The new rule would allow insurers to cover slightly fewer areas of health and still be counted at a certain medal level.

The rule also does project that this move will increase out-of-pocket costs for Americans in the short-run, but said that it should lower premiums to offset this in the long-run.

"The proposed change in AV could reduce the value of coverage for consumers, which could lead to more consumers facing increases in out-of-pocket expenses, thus increasing their exposure to financial risks associated with high medical costs," reads the rule. "However, in the longer run, providing issuers with additional flexibility could help stabilize premiums, increase issuer participation and ultimately provide some offsetting benefit to consumers."

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SCOTUS hears Obamacare contraceptives challenge
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SCOTUS hears Obamacare contraceptives challenge
WASHINGTON, DC - MARCH 23: Nuns supporting Little Sisters of the Poor, attend a rally in front of the US Supreme Court, March 23, 2016 in Washington, DC. Today the high court will hear arguments in Little Sisters v. Burwell, which will examine whether the governments new health care regulation will require the Little Sisters to change their healthcare plan, to other services that violate Catholic teaching. (Photo by Mark Wilson/Getty Images)
WASHINGTON, DC - MARCH 23: Nuns supporting Little Sisters of the Poor, attend a rally in front of the US Supreme Court, March 23, 2016 in Washington, DC. Today the high court will hear arguments in Little Sisters v. Burwell, which will examine whether the governments new health care regulation will require the Little Sisters to change their healthcare plan, to other services that violate Catholic teaching. (Photo by Mark Wilson/Getty Images)
WASHINGTON, DC - MARCH 23: Nuns supporting Little Sisters of the Poor, attend a rally in front of the US Supreme Court, March 23, 2016 in Washington, DC. Today the high court will hear arguments in Little Sisters v. Burwell, which will examine whether the governments new health care regulation will require the Little Sisters to change their healthcare plan, to other services that violate Catholic teaching. (Photo by Mark Wilson/Getty Images)
WASHINGTON, DC - MARCH 23: Nuns supporting Little Sisters of the Poor, attend a rally in front of the US Supreme Court, March 23, 2016 in Washington, DC. Today the high court will hear arguments in Little Sisters v. Burwell, which will examine whether the governments new health care regulation will require the Little Sisters to change their healthcare plan, to other services that violate Catholic teaching. (Photo by Mark Wilson/Getty Images)
WASHINGTON, DC - MARCH 23: Nuns supporting Little Sisters of the Poor, attend a rally in front of the US Supreme Court, March 23, 2016 in Washington, DC. Today the high court will hear arguments in Little Sisters v. Burwell, which will examine whether the governments new health care regulation will require the Little Sisters to change their healthcare plan, to other services that violate Catholic teaching. (Photo by Mark Wilson/Getty Images)
WASHINGTON, DC - MARCH 23: Nuns supporting Little Sisters of the Poor, attend a rally in front of the US Supreme Court, March 23, 2016 in Washington, DC. Today the high court will hear arguments in Little Sisters v. Burwell, which will examine whether the governments new health care regulation will require the Little Sisters to change their healthcare plan, to other services that violate Catholic teaching. (Photo by Mark Wilson/Getty Images)
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"This proposal will take steps to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options," said Patrick Conway, acting CMS administrator. "They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated."

Here's a quick rundown of some of the other proposed changes:

  • Give insurers more time to figure out their 2018 plans: Insurers have expressed concerns over uncertainty regarding the repeal and replacement of Obamacare by Republicans. This uncertainty, coupled with enrollment data, has already led one of the largest insurers — Humana — to announce plans to leave the market. Others are considering their offerings. The date to submit 2018 plans to the federal and state governments in April. The new rule said that if the other changes are accepted, CMS would issue "separate guidance" on the deadline for insurers.
  • Increased scrutiny during special enrollment periods: The rule would force people that enroll outside of the open enrollment period to provide additionally documentation to be allowed access to coverage. It would allow people who lose employer coverage due to a job status change to gain access, but prevent people from waiting until they get sick to sign up for plans. This is a long standing idea to prevent abuses of the special enrollment periods. A similar proposal came from the Obama administration.
  • Force beneficiaries to pay back owed premiums before getting the next year's coverage: The new rule would allow insurers to "to collect premiums for prior unpaid coverage" before the person was allowed to sign up for a plan from the same insurer the next year.

Some of these changes had been proposed by the Obama administration in August in order to address the imbalance in the exchanges.

The open enrollment tweak may be the most significant departure from the Obama era, however. The CMS rules from August tried to expand outreach and sign-ups for the open enrollment period, allocating more money toward advertising efforts.

Not only did Trump's team pull back from a good portion of a $5 million ad buy for the 2017 open enrollment, but the shortened open enrollment period could also make it much more difficult to grow sign-ups or keep the number of people enrolled at the same level in 2018.

Open enrollment already fell in 2017 from the year before, mostly due to a significant deceleration in sign-ups after Trump took office.

The new rules drew some criticism from health policy experts. Larry Levitt, senior vice president at the health policy think tank Kaiser Family Foundations, tweeted that the rules "strike me as making things less consumer friendly and more insurer friendly."

The proposed changes are open to public comment until March 7, according to the filings with the Federal Registry.

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Donald Trump's first day as president
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Donald Trump's first day as president

White House Staff Secretary Rob Porter (2nd R) gives U.S. President Donald Trump, flanked by Vice President Mike Pence (L) and Chief of Staff Reince Priebus (R) the document to confirming James Mattis his Secretary of Defense, his first signing in the Oval Office in Washington, U.S. January 20, 2017.

(REUTERS/Jonathan Ernst)

President Donald Trump turns to House Speaker Paul Ryan as he is joined by the Congressional leadership and his family as he formally signs his cabinet nominations into law, in the President's Room of the Senate, at the Capitol in Washington, D.C., U.S., January 20, 2017.

(REUTERS/J. Scott Applewhite/Pool)

US President Donald Trump formally signs his cabinet nominations into law, at the Capitol in Washington, January 20, 2017.

(REUTERS/J. Scott Applewhite/Pool)

US President Donald Trump signs an executive order as Vice President Mike Pence looks on at the White House in Washington, DC on January 20, 2017.

(JIM WATSON/AFP/Getty Images)

President Donald Trump is joined by the Congressional leadership and his family as he formally signs his cabinet nominations into law, in the President's Room of the Senate, at the Capitol in Washington, D.C., U.S., January 20, 2017.

(REUTERS/J. Scott Applewhite/Pool)

US President Donald Trump signs an executive order as Vice President Mike Pence and Chief of Staff Reince Priebus look on at the White House in Washington, DC on January 20, 2017.

(JIM WATSON/AFP/Getty Images)

President Donald Trump shakes hands with Senate Minority Leader Chuck Schumer, D-N.Y, as he is joined by the Congressional leadership and his family while he formally signs his cabinet nominations into law, at the Capitol in Washington, January 20, 2017. From left are Senate Majority Leader Mitch McConnell, R-Ky., Senate Minority Leader Chuck Schumer, D-N.Y, Sen. Roy Blunt, R-Mo., Vice President Mike Pence and his wife Karen Pence, Jared Kushner, Donald Trump Jr., and Ivanka Trump.

(REUTERS/J. Scott Applewhite/Pool)

US President Donald Trump is joined by the Congressional leadership and his family, rear, wife Melania Trump, son Barron Trump, as he formally signs his cabinet nominations into law, at the Capitol in Washington, January 20, 2017.

(REUTERS/J. Scott Applewhite/Pool)

President Donald Trump prepares to sign a confirmation for Defense Secretary James Mattis as his Chief of Staff Reince Priebus (L) points to the order while Vice President Mike Pence watches January 20, 2017 in Washington, DC.

(Photo by Kevin Dietsch - Pool/Getty Images)

President Donald Trump is joined by the Congressional leadership and his family as he formally signs his cabinet nominations into law, in the President's Room of the Senate, at the Capitol in Washington, D.C., U.S., January 20, 2017.

(REUTERS/J. Scott Applewhite/Pool)

President Donald Trump signs his first executive order as president, ordering federal agencies to ease the burden of President Barack Obama's Affordable Care Act January 20, 2017 in Washington, DC.

(Photo by Kevin Dietsch - Pool/Getty Images)

President Donald Trump is joined by the Congressional leadership and his family as he formally signs his cabinet nominations into law, in the President's Room of the Senate, at the Capitol in Washington, D.C., U.S., January 20, 2017.

(REUTERS/J. Scott Applewhite/Pool)

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