Obamacare’s Essential Health Benefits Are Ripe for Change


The Trump administration is “all in” on pushing for Congress to enact Obamacare repeal-replace legislation, White House health-care economic adviser Brian Blase told me recently. So they aren’t saying much about what the Department of Health and Human Services could do to make regulatory changes to the law if Congress doesn’t pass a bill. That could undercut their argument that repeal-replace legislation is needed.

But in interviews with health-care industry consultants, analysts and lobbyists, one theme that emerged is the Department of Health and Human Services has the most latitude to change regulations governing essential health benefits (EHBs), 10 broad categories of care that ACA exchange plans must cover. The categories include maternity care, prescription drugs and mental health, expensive coverage that individual plans often didn’t cover prior to passage of the ACA in 2010.

“EHBs are generally described in law but most of the specific requirements are prescribed in the regulation” issued by the Obama administration HHS in 2013, Manatt Health managing partner Joel Ario told me. Ario was the first director of HHS’s Office of Health Insurance Exchanges in 2010-2011 during the Obama administration.

Currently, most states require that the EHBs match those of the largest small group plan in their state. The Trump administration could broaden the types of plans that states could use as benchmarks for EHBs, Tom Miller, a resident fellow at the American Enterprise Institute (AEI), told me. The AEI is a free-market oriented think tank, and Miller has been critical of the ACA.

“There’s nothing locked and fixed in the EHBs other than proxy measures,” Miller said. HHS has “some flexibility,” he said. Still, “The entire world won’t change tomorrow though,” even if the HHS does loosen EHB requirements, he said.

Read my full article here.

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