The Health 202: The Trump administration is giving states another way around Obamacare regulations


Any day now, the Trump administration is expected to release a final rule that could significantly scale back the minimum health benefits guaranteed to individuals insured under the Affordable Care Act.

In the meantime, the GOP-led administration is offering states some tools they could use to reduce these “essential health benefits” once the new rule lands – the latest evidence the president and his appointees are serious about weakening Obamacare regulations as much as possible without help from an impossibly divided Congress.

States have nearly three weeks to apply for a total of $8 million in funding to be used for “implementing the insurance market reforms and consumer protections” laid out under the 2010 health-care law, according to a notice of funding posted Monday by the Centers for Medicare and Medicaid Services. The funds are left over from a pot of money originally used to help states review insurers’ proposed rate hikes.

To be sure, $8 million is mere pocket change for CMS. But the dollars could be instrumental for states – especially small ones – seeking to dial down health benefits insurers are required to cover under Obamacare. For example, states could use their share to hire an actuary or a clinician to form leaner coverage requirements for, say, maternity care or mental health services, to replace the benchmark plans they currently have in place.

“This is about helping state departments of insurance do their job better,” Michael Adelberg, a principal at Faegre Baker Daniels Consulting, told me Tuesday. “You’re letting them add tools to the toolbox.”

This whole effort stems from Republicans’ enduring opposition to regulations imposed upon insurers under the ACA, which among other things require them to cover 10 categories of care to ensure consumers on the individual market can access a full range of benefits.

These essential health benefits (or EHBs) are among the Obamacare regulations that Republicans have blamed for skyrocketing premiums in the marketplaces, as they mean everyone buys plans with benefits they may not need or want. While EHBs are a major boon to certain customers – like a young woman who may need maternity coverage, for example – they also mean those individuals with fewer health-care needs may not be able to purchase as lean or as cheap of a plan as they may want.

During the debate last year about repealing and replacing the ACA, Republicans on Capitol Hill argued passionately about scrapping the health-coverage requirements. That repeal effort stalled, but CMS in October proposed a massive, 365-page rule suggesting an array of changes to how individual and small business plans are run.

States, insurers and health providers are anxiously awaiting imminent release of the final rule, which is currently being reviewed by the White House Office of Management and Budget. CMS didn’t respond to an inquiry about when it is expected to be finalized.

On EHBs, the proposed rule says states won’t have to choose from a limited fixed menu of benchmark plans to set their minimum coverage requirements. Instead, they’d be able to select a la carte. For example, Ohio could choose the ambulatory care standards from one benchmark plan and the preventive services from another. Wisconsin could choose the benchmark plan from North Dakota or New Jersey or Virginia.

If states want to go this route, they could use the new funding announced this week, according to the language in the CMS notice. The notice says “states may use funds to assess whether potential modifications to the set of benefits included in the state’s EHB-benchmark plan or medication of specific categories of benefits will increase affordability for consumers.”

In other words, the Trump administration is encouraging states to find ways to make Obamacare marketplace plans cheaper by allowing insurers to sell leaner, less expensive coverage.

Potential changes to EHBs are prompting heavy pushback from many health-care advocates, who are loath to see reduced benefits in the plans available to Americans – especially those who don’t have access to employer-sponsored coverage.

More than 100 patient and community organizations wrote to Verma last year that they are “very concerned that the proposed changes to how the state can select their essential health benefits will diminish patient care and increase beneficiary’s out of pocket costs.”



Please enter your comment!
Please enter your name here