The Trump administration recently finalized a major regulation governing the Affordable Care Act marketplaces, and community health plans are raising concerns about the impact the changes could have on consumers.
Heather Foster, vice president of market policy at the Association of Community Affiliated Plans (ACAP), told Fierce Healthcare in an interview that one of the biggest challenges for group members is precisely the timing of periods.
The proposal was first issued in February and was finalized last Friday. Foster said that means plans are adapting to the regulation amid preparing their bids for 2027. The rule is typically issued earlier and finalized early in the year to account for this timeline; for example, the Notice of Pay and Benefit Parameters (NBBP) 2026 was finalized in mid-January 2025.
“This is months later than usual, so everything is compressed,” Foster said, “and you’re adding more things they have to do in a shorter period of time. It’s difficult.”
Operating on a condensed schedule like this, he said, also forces plans to shift their focus to other planning that begins later in the year.
Margaret Murray, ACAP Executive Director said in a statement Following the final rule that plans operate on a condensed schedule or with only one proposed rule to work with could also result in downstream effects for consumers as plans make decisions with incomplete information.
“The plans need time to implement policy changes in ways that protect consumers and preserve market stability,” Murray said. “Publishing the NBPP in the middle of the bidding cycle is not a sustainable practice.”
Additionally, the organization expressed concern about the impact of the expansions for both catastrophic and out-of-network plans. In the rule, the Centers for Medicare and Medicaid Services establishes a framework for out-of-network plans that will take effect in 2028.
And while that gives insurers time to adapt, Murray said these plans have the potential to “undermine the basic premise of Marketplace plans: that they provide access to care at an affordable and predictable cost.”
These plans lack traditional negotiated provider networks and instead often rely on a reference pricing model to pay for patient care. Foster said the design requires a significant amount of work, as plans often do, and instead puts it in the hands of the consumer.
While they may be attracted by the possibility of lower premiums and upfront costs, they will also have to spend time digging into how their plan works, what the costs may be for specific services and how much they might be billed for the care they need, he said.
“There is an administrative burden on the consumer – God forbid they are sick and incapable – but there is also a huge financial risk for them,” he said. “What happens if the care they need far exceeds what will be covered?”
Another issue to consider, he said, is that these plans would compete directly with the coverage that a traditional network has on an equal basis, although the consumer experience would be significantly different if they made the change.
Similarly, the NBPP would allow people to enroll in catastrophic plans for several years without requiring annual verification. These plans also typically have lower premiums, but that’s in exchange for a higher deductible or out-of-pocket costs.
Murray said in the statement that the move “bodes poorly for market stability and erodes consumer protection.”
“Healthier enrollees drawn from the regular Marketplace lose comprehensive coverage with premium tax credits to make them more affordable,” he said. “Consumers may postpone needed care because they are forced to choose between seeing a doctor to check for an unexplained lump or putting gas in their car.”
“And when care is delayed, everyone pays the price,” Murray said.
Foster said expanding these plans could affect at-risk groups in multiple ways. Removing the healthiest people from the usual risk group through catastrophic plans would lead to a sicker mix on most medical levels.
CMS also raised questions about possible pooling of risk groups, and Foster said that would likely negate the premium benefits of catastrophic plans, since premium costs would be based on the pooled benchmarks.
“I think no matter which direction you go, you run the risk of having unintended consequences,” he said.
The rule also comes at a time of notable upheaval for exchanges following the expiration of post-COVID tax credits that boosted enrollment as well as important program integrity measures. Both factors played a major role in increasing premiums for 2026, which is leading many people to exit the market.
With many questions remaining surrounding the NBPP final rule, this adds to the sense of uncertainty, Foster said.
“I think this rule introduces even more uncertainty at a time of market uncertainty,” he said. “There are already many changes [and] uncertainty, and we simply don’t know what the impact of many of these newer proposals will be.
