The Trump administration will allow states more flexibility in determining what health services insurance plans must cover, finalizing a proposal that drew protests from major physicians’ groups.
The Centers for Medicare & Medicaid Services (CMS) on Monday said a new rule will provide states with more options for their essential health benefit (EHB) benchmark plan. While they had been limited to 10 options, states will now be able to choose from the 50 EHB-benchmark plans used for the 2017 plan year in other states or select specific EHB categories, such as drug coverage or hospitalization, from among the categories used for the 2017 plan year in other states.
CMS said this will result in more affordable health plans.
Other Insurance Changes
The Trump administration also made several other changes through the final rule for the requirements that will shape the plans that insurers offer in 2020. Because of the time needed for such rulemaking, this marks in some ways a first major set of revisions under the Republican administration to the insurance framework established by the Affordable Care Act.
The final rule released Monday amends medical-loss ratio to allows states to request what CMS terms “reasonable adjustments” to the standard for the individual market if the state shows this could help stabilize its individual insurance market.
Medical Groups Protest
Influential medical groups had sought last fall to dissuade CMS from the EHB change, which the agency proposed last year. As of midday Tuesday, major associations for physicians were still working their way through the final rule, which runs to more than 500 pages, and had not issued statements on it.
But the CMS plans to change the essential health benefits rule earlier alarmed groups such as the American Academy of Family Physicians. In a November comment to CMS, the group acknowledged that the proposed changes to EHB requirements might decrease cost and thus attract younger and healthier people into insurance plans, an approach that might help keep rising premiums in check. But these changes might jeopardize coverage for people with serious medical conditions, the group said.
“While ratcheting down EHBs may reduce upfront premium costs, it could have devastating financial implications for families with the sickest patients whose insurance coverage may not cover medically necessary services,” wrote John Meigs Jr, MD, board chair of the American Academy of Family Physicians, in a letter to CMS.
The American Medical Association (AMA) also raised similar concerns in its comments on the proposed EHB changes.
“Under current law, the requirement that all qualified health plans offer at least the EHBs in the EHB package has helped ensure that individuals have access to meaningful coverage,” wrote James L. Madara, MD, chief executive of the AMA, in a November letter to CMS. This approach “strikes a balance between offering meaningful coverage and maintaining patient choice in health plans and their respective benefits packages.”
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