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New Rule Would Let States Decide Essential Health Benefits

by Countable | 11.1.17

What’s the story?

On Friday, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would allow states to decide what essential health benefits (EHBs) are covered by health insurance plans.

Currently, the Affordable Care Act (commonly known as Obamacare) requires that insurers cover at least 10 EHBs, including maternity care, mental health services, substance abuse services, and prescription drugs.

The new CMS rule would also allow states to remove the regulation that requires insurers in the Obamacare exchanges cover a certain amount of claims. In the present system, the "medical loss ratio provision" requires that insurers spend 80 percent or more of premium payments on healthcare and improving the quality of care.

"Consumers who have specific health needs may be impacted by the proposed policy," the agency said. They continued:

"In the individual and small group markets, depending on the selection made by the state in which the consumer lives, consumers with less comprehensive plans may no longer have coverage for certain services. In other states, again depending on state choices, consumers may gain coverage for some services."

CMS is accepting public comments through November 27, 2017 here.

Why does it matter?

In January, President Donald Trump signed an executive order that directed the Department of Health and Human Services (HHS) to "exercise all authority and discretion" to “minimize the unwarranted economic and regulatory burdens of [Obamacare], and prepare to afford the States more flexibility and control to create a more free and open healthcare market.”

Essential health benefits are a cornerstone of Obamacare, ensuring everyone with health insurance has access to certain healthcare benefits. But critics have said that EHBs raise healthcare costs for everyone. By removing EHBs, Healthcare Dive wrote, "health insurance plans would return to the days before the ACA when states decided mandated coverage requirements."

The proposed rule could result in states allowing insurers to offer less comprehensive plans that cost less than plans currently available to consumers.

After Republicans failed to pass their healthcare bill, the Trump administration has been chipping away at Obamacare where it could. Some of the actions taken include shortening the exchange sign-up period, slashing the advertising budget used to promote enrollment, issuing executive orders, and ending the cost-share reduction payments.

What do you think?

Do you support the CMS rule change? Which is more important to you: "consumers with less comprehensive plans may no longer have coverage for certain services" or “in other states…consumers may gain coverage for some services”? Should all consumers be entitled to essential health benefits? Or should states have the flexibility to allow insurers to offer plans that vary in the benefits offered and premiums charged?

Hit Take Action, tell your reps, then tell your fellow citizens below.

And be sure to comment with CMS.

— Josh Herman

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(Photo Credit: AlexLMX / iStockphoto)

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