One of the primary themes of the Trump administration is to return power to the states to regulate health-care markets. To that end the Department of Health and Human Services emphasized giving states more flexibility in running the Obamacare exchanges in its first major rulemaking.
Under the so-called payment notice proposed for the 2019 federal HealthCare.gov exchanges used by 39 states, state regulators could choose from a range of options in determining the essential health benefits that individual and small group health plans are required to cover under the Affordable Care Act.
The essential health benefits are patterned after typical employer plans, and include 10 broad categories including outpatient care, hospitalization and emergency services, maternity and pediatric care, prescription drugs, mental health, and preventive services. Most states have chosen the largest small group plan offered in their state as the benchmark on which coverage must be based.
If the proposal is finalized, however, states will be able to choose from plans and categories of coverage offered in other states, or design their own essential health services benefits—as long as the new benefits aren’t more generous than what is currently covered.
Some states may try to redesign benefits to reduce costs and attract more young enrollees, which the exchanges have lagged in doing.
Oklahoma, which earlier this year withdrew its application to make changes to the ACA to reduce premiums in the state, could rethink its plans. “We were prepared at one time to consider many of the changes that are being identified” in the 2019 payment notice, Mike Rhoads, deputy commissioner of life and health insurance in Oklahoma’s Insurance Department, told me.
Prescription drugs may be the most likely category in which states could seek to make changes. Patient groups like The AIDS Institute are worried about that, Deputy Executive Director Carl Schmid told me. “Given this administration, they are all about limiting benefits. We would be very concerned about that,” he said.
The HHS estimates that 10 states a year could take advantage of the plan if it’s finalized.
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