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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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(65)
  • Brian
    11/01/2017
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    I strongly oppose the state having the option decide what is a essential health benefit and what is not essential benefit there must be a standard across the board

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  • I.Got.an.Idea...
    11/01/2017
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    We are the United States of America. All citizens of the country should have the same benefits available across the Country, as one entity. Why do Republicans say they want Government to stay out of their business, yet they propose a Government that is controlling the individual lives of citizens. They want the federal government to stay out of states individual policies, yet they want to push other specific items off to the states. They pick and choose items for policy for states and federally, just like they interpret the Bible, in the manner that they want to use it to oppress the Citizens and profit financially. Obsessed with greed and narcissistic power are primitive behaviors that only contribute to hurting innocent people in today’s modern societies.

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  • Mary
    11/01/2017
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    Medicare for all. One payer system. Universal health care. How many different ways must i

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  • TinyBA13
    11/01/2017
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    I strongly oppose any move to reduce what is considered essential health benefits. It would be ok if states wanted to add essential benefits, but not reduce them. Certain states would move to restrict women health access and those for LGBTQ identified people without a doubt. Skimpier plans would also threaten public health by potentially reducing screenings and access to basic preventative measures like immunization.

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  • Michael.J.L
    11/01/2017
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    No way! This is just another back-door mechanism to destroy what is left of the ACA and turn the clock back on Healthcare. Let's turn the clock forward and go Single-Payer. Quality healthcare for EVERYONE is a human right.

    Like (9)
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  • Hillary
    11/01/2017
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    Essential health benefits must absolutely be required for all healthcare plans. They cannot be turned over to the states to pick and choose. This is another way the GOP are trying to take away healthcare from folks with pre-existing conditions by pricing us all out of the market. The days before Obamacare meant I can buy a cheap healthcare plan but it won't cover anything! These plans were predatory. They gave people the feeling that they had coverage but bankrupted them when they needed to use it. Please stop trying to dismantle the ACA! It was the best thing to happen to healthcare for decades! I don't understand why you don't want families to have essential health benefits. Also please fund CHIP. It's been a month and sick kids still have no healthcare.

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  • Billie
    11/01/2017
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    I guess the Republicans in Congress didn’t hear the people when they said no to repeal and replace.

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  • Deirdre
    11/02/2017
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    So now we are going to have to move to states that will offer the insurance we need!

    Like (7)
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  • Dean
    11/01/2017
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    I oppose states making this decision. This is just another attempt to dilute the ACA.

    Like (5)
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  • Loretta
    11/02/2017
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    So what is the sense in spending money on insurance that doesn’t cover any services you actually need? Back to wealth care ...thank you Mr T

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  • Jimalea
    11/02/2017
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    Medicare for all is the only way I see that the healthcare system would be become "healthy" again. I wish they realized how far we lag behind other nations in keeping the population healthy.

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  • Donna
    11/02/2017
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    Isn't it bad enough that this administration has gone out of its way to destroy not only the accessibility to healthcare but the health and lives of Americans? Giving states the right to decide what EHBs are will do nothing but create confusion and increased costs for ALL consumers. This will not only affect the individual market -- it will affect ALL health insurance policies across the board, with the possible exception of the ones offered to the members of Congress. The ACA is not perfect but it has provided insurance to many people who were previously priced out of the market. This proposal, along with all the other ones aimed at killing the ACA, will do nothing to lower the cost of health care in this country. It will only increase the out of pocket expenses for the majority of Americans. Low premiums don't do anyone any good if their policy doesn't cover any actual medical expenses. I think it is time our representatives stopped grandstanding from their respective partisan corners and actually started working on a solution to this problem. After all, isn't that why we pay their salaries and their health insurance premiums?

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  • Eric
    11/02/2017
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    This does not faithfully uphold the current law, ACA. Until there is enough support to repeal the ACA, which there is not either among senators or the public, this is an unlawful and underhanded attempt to undermine current law.

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  • Gwendlyn
    11/02/2017
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    Giving the States this type of power would leave hundreds of thousands of citizens with shoddy health coverage. This would be a huge mistake.

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  • KansasTamale
    11/02/2017
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    This is STUPID. KANSAS IS AN EXAMPLE. WE DONT HAVE ACA. WE HAVE BROWNBACK KANCARE & IT STINKS. NO WAY IS THIS GOING TO HELP PEOPLE.

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  • Deb
    11/02/2017
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    This another back door to destroying healthcare coverage for women, the disabled and chronically ill. It never will work at the state level

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  • Robert
    11/02/2017
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    Healthcare should be for all or nun and my wife’s case we had good insurance but was canceled when she had breast cancer and was not able to get affordable care anywhere until Obamacare came out. So thank you Obamacare now the Republican are doing all they can to take it away again what a bunch of rich spoiled well enough said

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  • Dennis
    11/02/2017
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    This is part of the GOP’s plan to undermine healthcare in our country. Allowing the individual states to decide what constitutes essential healthcare benefits is another GOP nod to states-rights—in this case, leading to a race to the bottom in healthcare.

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  • JTJ
    11/01/2017
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    The federal government should not be involved in health insurance period. This is a very small step in the right direction.

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  • Diane
    11/02/2017
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    This would be awful for people who have to move to a different state!

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