States Looking for Health Plan Savings Under Trump Rule


Look for states to take more action to find ways to get Obamacare health plan costs down now that the Trump administration has issued a rule encouraging them to.

The Health and Human Services Department rule gives states more options in setting the Affordable Care Act’s essential health benefit requirements, among other things. Under the Affordable Care Act, plans must cover 10 broad categories of services, including hospital care, doctors’ services, prescription drugs, maternity care, and mental health services.

Those categories still must be covered, but states will have more flexibility in defining how they are covered. For instance, states could now choose drug benefits that cover fewer drugs.

In addition, the HHS is streamlining enrollment for the Small Business Health Options Program exchanges by eliminating online enrollment requirements.

While some states are expected to use the rule to try to get soaring individual market premiums down, other actions taken by the Republican Congress and the Trump administration “are much more likely to drive the premium landscape than this rule will specifically,” Avalere Health vice president Elizabeth Carpenter told me.

The 2017 repeal of the individual mandate penalty for not having qualified coverage, the Trump administration’s plan to allow more health plans that don’t meet ACA requirements, and Congress’s failure to enact a market stabilization plan are all likely to increase premiums, Carpenter said.

Major exchange insurers include Centene Corp., Anthem Inc., and Molina Healthcare Inc. Nearly 11.8 million people enrolled in the ACA exchanges for 2018.

Read my full article here.

Stay on top of new developments in health law and regulation, and learn more, by signing up for a free trial to Bloomberg Law.