The Department of Health and Human Services has drafted rules that would, starting in 2019, allow states to change the benefits health plans must provide and limit enrollment help for consumers.
The Washington Post reports that Republicans are still working to weaken federal powers under the 2010 health-care law and eliminate numerous provisions that have allowed millions to buy health insurance under the Affordable Care Act. After Republicans failed to pass any of their repeal-and-replace proposals this year in Congress, they are instead taking aim at rule changes that, although they don't go as far as changes in the law itself, will still take a toll on the program.
While the draft rule would still require ACA plans to cover 10 categories of medical services, the report says, for the first time, any state could choose to use benefits standards that are already in use by another state, or even to rewrite its own. This could reduce the number of visits that are covered for some kinds of care or cut hospital stays, according to health policy experts.
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The draft would undo a requirement for each ACA marketplace's geographic area to have at least two enrollment-assistance organizations, known as navigators, and that one of them be a consumer-oriented nonprofit. Instead, one navigator would satisfy the new requirement, and won't even have to be in the same physical location as the area it would serve. The proposal says that would allow ACA exchanges "to more easily operate these programs with limited resources."
In addition, the proposal would hang states, or outside accreditors, with the full responsibility to determine whether each marketplace health plan has enough doctors and other care providers in its network to guarantee patients "reasonable access." That would cancel out the government's earlier efforts to make federal network standards stronger under the ACA.
The draft would also allow states, with federal permission, to no longer require insurers selling individual health plans to devote at least 80 percent of the premiums they collect toward customers' care. That would let insurers in volatile markets earn more profits out of the revenue they receive.
Unlike earlier draft updates to ACA marketplace rules, the draft was posted quietly at the end of last week by the Office of Management and Budget without announcement. Its tone also differs substantially from earlier iterations, taking a critical view of the ACA that posits market destabilization because of the law.
Without knowing the actions states would take under the proposed rules, it's difficult to predict its effect on the law, according to experts. The report quotes Michael Adelberg, a principal at Faegre Baker Daniels Consulting who helped to implement parts of the ACA during the previous administration, saying that "allowing substitutions" within the law's benefit categories could affect available health plans, "assuming the states want to go there."
Claire McAndrew at Families USA, a consumer health lobby, is quoted saying that the prospect of fewer navigators, looser benefits rules and a decrease in the percentage of revenue that insurers must spend on health services "will harm consumers' ability to get and maintain high-quality, affordable, comprehensive health coverage and care."
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