TL/DR –
The Trump administration has proposed a healthcare reform, known as the 2027 ACA Exchange Rule, which would allow health insurers to offer non-network plans on market exchanges. Under the new rule, health insurers would set a ‘reference price’ for a procedure that applies to all providers, with the insurer responsible only for the reference price. It would allow patients access to the entire market, however, they may have to pay out of pocket if the procedure costs are higher than the reference price.
Proposed Healthcare Reforms Under Trump’s Administration Could Radically Change U.S. Health System
The Trump administration is proposing a healthcare reform, the 2027 ACA Exchange Rule, that has the potential to fundamentally alter the U.S. health system in a manner akin to the impact of Barack Obama’s Affordable Care Act.
Under this proposed reform, health insurers would have the capability to offer nonnetwork plans on market exchanges where individuals typically purchase their insurance. Currently, the majority of healthcare plans only cover care from providers they have an existing contract with. With this new rule, health insurers can set “reference prices” for procedures, applicable regardless of the provider chosen by the patient.
If a procedure receives approval, it opens up the entire market to the patient, with the understanding that the insurer will cover only up to the reference price. This gives patients the freedom to select any facility for their procedure. However, patients may need to cover additional costs out-of-pocket if the cost of the procedure exceeds the established reference price.
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