Trump Offers State Flexibility in Obamacare Regulation (1)

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By Sara Hansard

Greater state flexibility is among the goals of a new Obamacare final rule from the Trump administration.

The state-friendly provisions in the Health and Human Services Department’s rule issued April 9 include giving states more options to select an essential health benefit (EHB) benchmark plan and to allow its issuers to substitute benefits across EHB categories. The HHS said it also will permit streamlining of the enrollment process through the Small Business Health Options Program (SHOP) Exchanges by eliminating online enrollment requirements.

The final rule, which sets the requirements for the 2019 health insurance exchanges, is the Trump administration’s first major Affordable Care Act final rule. Obamacare has helped expand health-care coverage but has also led to premium spikes and less coverage in the non-group health insurance market—something the administration noted in its April 9 description of the new rule.

St. Louis-based Centene Corp. is the largest exchange operator, with 1.6 million members in 2018. Other major health insurers operating in the Obamacare exchanges include Anthem Inc. and Molina Healthcare Inc. For 2018, nearly 11.8 million people have signed up for insurance on the ACA exchanges.

The rule (RIN:0938-AT12) will be published April 17. Its full title is Benefit and Payment Parameters for 2019.

ACA Exemptions

In an April 9 briefing, federal officials told reporters that the new rule and associated guidance from the HHS will provide a hardship exemption from the ACA’s coverage requirement in certain circumstances. People living in counties with no insurance issuer, or only one issuer, won’t be fined for lacking ACA coverage, Centers for Medicare & Medicaid Services Administrator Seema Verma said.

More than half the U.S. counties only have one issuer; no counties lack an ACA issuer at this time, Verma said.

Hardship exemptions from the coverage requirement also are available for certain people who object to abortion. These exemptions are available for consumers who don’t have have issuers available that decline to cover abortion services, according to the HHS briefing.

These exemptions are available immediately, according to the HHS, even though the rule is for 2019.

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