Any day now, the Trump administration is expected to release a final rule that could significantly scale back the minimum health benefits guaranteed to individuals insured under the Affordable Care Act.
In the meantime, the GOP-led administration is offering states some tools they could use to reduce these “essential health benefits” once the new rule lands — the latest evidence the president and his appointees are serious about weakening Obamacare regulations as much as possible without help from an impossibly divided Congress.
States have nearly three weeks to apply for a total of $8 million in funding to be used for “implementing the insurance market reforms and consumer protections” laid out under the 2010 health-care law, according to a notice of funding posted Monday by the Centers for Medicare and Medicaid Services. The funds are left over from a pot of money originally used to help states review insurers’ proposed rate hikes.
To be sure, $8 million is mere pocket change for CMS. But the dollars could be instrumental for states — especially small ones — seeking to dial down health benefits insurers are required to cover under Obamacare. For example, states could use their share to hire an actuary or a clinician to form leaner coverage requirements for, say, maternity care or mental health services, to replace the benchmark plans they currently have in place.
“This is about helping state departments of insurance do their job better,” Michael Adelberg, a principal at Faegre Baker Daniels Consulting, told me yesterday. “You’re letting them add tools to the toolbox.”
This whole effort stems from Republicans’ enduring opposition to regulations imposed upon insurers under the ACA, which among other things require them to cover ten categories of care to ensure consumers on the individual market can access a full range of benefits.
These essential health benefits (or EHBs) are among the Obamacare regulations that Republicans have blamed for skyrocketing premiums in the marketplaces, as they mean everyone buys plans with benefits they may not need or want. While EHBs are a major boon to certain customers – like a young woman who may need maternity coverage, for example – they also mean those individuals with fewer health-care needs may not be able to purchase as lean or as cheap of a plan as they may want.
During the debate last year about repealing and replacing the ACA, Republicans on Capitol Hill argued passionately about scrapping the health-coverage requirements. That repeal effort stalled, but CMS in October proposed a massive, 365-page rule suggesting an array of changes to how individual and small business plans are run.
States, insurers and health providers are anxiously awaiting imminent release of the final rule, which is currently being reviewed by the White House Office of Management and Budget. CMS didn’t respond to an inquiry about when it is expected to be finalized.
On EHBs, the proposed rule says states won’t have to choose from a limited fixed menu of benchmark plans to set their minimum coverage requirements. Instead, they’d be able to select a la carte. For example, Ohio could choose the ambulatory care standards from one benchmark plan and the preventive services from another. Wisconsin could choose the benchmark plan from North Dakota or New Jersey or Virginia.
If states want to go this route, they could use the new funding announced this week, according to the language in the CMS notice. The notice says “states may use funds to assess whether potential modifications to the set of benefits included in the state’s EHB-benchmark plan or medication of specific categories of benefits will increase affordability for consumers.”
In other words, the Trump administration is encouraging states to find ways to make Obamacare marketplace plans cheaper by allowing insurers to sell leaner, less expensive coverage.
Potential changes to EHBs are prompting heavy pushback from many health-care advocates, who are loath to see reduced benefits in the plans available to Americans — especially those who don’t have access to employer-sponsored coverage.
More than 100 patient and community organizations wrote to Verma last year that they are “very concerned that the proposed changes to how the state can select their essential health benefits will diminish patient care and increase beneficiary’s out of pocket costs.”
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AHH: Among all the conservative changes the Trump administration is considering for Medicaid, it's also contemplating allowing lifetime limits on health-care benefits similar to caps in place for federal welfare benefits, McClatchy's Tony Pugh reports. Such a move would add to the list of potential new requirements states could start imposing on recipients, as the administration seeks to put some more fences around the safety-net program.
"If approved, the dramatic policy change would recast government-subsidized health coverage as temporary assistance by placing a limit on the number of months adults have access to Medicaid benefits," Tony writes. "At least five states — Arizona, Kansas, Utah, Maine and Wisconsin — are seeking waivers from the Trump administration to impose lifetime Medicaid coverage limits. The Department of Health and Human Services said it could not comment on the pending applications."
OOF: The Trump administration missed a deadline last fall for providing critical grant information to local agencies, but officials insisted yesterday there will be “no gaps in service” in the country's $260 million family-planning program, the AP reports. While the grant funding is expected to run out at the end of March, the Department of Health and Human Services said it is still committed to the program, which helps about 4 million women every year by distributing grants to qualified health-care providers around the country (including Planned Parenthood for services like birth control and preventative medical care).
“The Title X program is important to this administration,” Valerie Huber, the HHS official currently in charge of the program, wrote in an email to clinics, per the AP. “We are committed to the women and men who depend on Title X services and efforts are already underway to ensure that there will be no gaps in service while the funding announcement is finalized.”
It's unclear whether the delays are related to the abrupt resignation last month of the HHS official originally in charge of family planning. Rep. Diana DeGette (D-Colo.) said she wants more specifics. “A commitment to extending the funding in a timely manner that doesn’t disrupt service is good,” DeGette said. “Better would be concrete details and immediate follow-through.”
In November, The Health 202 reported on ways the Trump administration could restrict abortion providers by putting new restrictions on the Title X family planning program.
OUCH: Yesterday, Alabama filed a lawsuit against the maker of OxyContin for its contribution to the opioid epidemic -- just the latest of dozens of states and local governments suing drugmakers over the opioid crisis. Alabama Attorney General Steve Marshall announced the federal lawsuit against Purdue Pharma, claiming the company led a deceptive marketing campaign that misled patients about the risks of the drug, Reuters reports.
“It will take years to undo the damage but an important first step we must take is to hold the parties responsible for this epidemic legally liable for the destruction they have unleashed upon our citizens,” Marshall said in a statement.
Purdue denied the allegations, but said it would work to fight the crisis. “As a company grounded in science, we must balance patient access to FDA-approved medicines, while working collaboratively to solve this public health challenge,” the drug company said in a statement.
--As the end of government funding looms on Thursday (yes, this is happening again), Senate leaders were working yesterday to finalize a sweeping two-year budget deal that would include a defense spending boost Trump has long demanded alongside an increase in domestic programs Democrats are insisting on, The Post's Erica Werner and Mike DeBonis report.
A breakthrough is allegedly at hand, at least according to GOP leader Mitch McConnell (Ky.) and his Democratic counterpart Chuck Schumer (N.Y.). "The agreement McConnell and Schumer are contemplating would clear the way for a bipartisan accord that would break through the sharp divides that helped prompt a three-day government shutdown last month," Mike and Erica write. The tentative measure would include two years of funding for community health centers and postpone planned Medicaid cuts to hospitals serving larger shares of the low-income, along with extending some smaller health-care funding streams.
--What the potential agreement doesn't appear to include: Measures to stabilize the Obamacare marketplaces, which have now sort of lost their bipartisan sheen as Democrats insist on changes after Republicans ignored their pleas to keep the ACA's individual mandate (it was repealed in the tax overhaul).
Sen. Patty Murray (D-Wash.) -- who had forged an agreement with her Republican counterpart Lamar Alexander on the Health, Education, Labor and Pensions Committee to pay insurers for extra Obamacare discounts -- says that agreement is no longer valid because Republicans changed the playing field by dismantling the mandate. A Murray spokeswoman said the senator has "made clear that the bipartisan bill she originally agreed on with Chairman Alexander simply is not designed to fix" any of the problems Democrats say Republicans are causing for Obamacare by repealing the mandate and working through executive action to pull back on its regulations.
"There are new challenges Republicans should agree to resolve in order to ensure Alexander-Murray meets its original goals of bringing down families’ health care costs and stabilizing markets," the spokeswoman told The Health 202.
--The Health 202 often features prolific and punchy tweets from Andy Slavitt, the former UnitedHealth Group executive who helped implement the ACA during the Obama administration. Yesterday, Slavitt launched a bipartisan nonprofit aiming to find consensus on improvements to the U.S. health-care system, called the United States of Care. Rather than lobbying, the group will focus on policy and grass roots work to promote access to affordable care through ways that most Americans can back, Slavitt told his hometown paper the Minneapolis Star Tribune.
Slavitt said when Congress eventually takes another stab at overhauling health care -- perhaps in the next decade -- his new group wants to be instrumental in spelling out the goals that the public could get on board with. "People around health care are concerned that if we wait for Washington to fix things, we're point to end up with either a solution that is only backed by one party or we'll remain in a volatile situation," Slavitt told the Star Tribune.
Prominent surgeon Atul Gawande is participating:
We’ll will be sick one day. We’ll have our share of chronic illnesses. When people have a regular source of care and can afford their meds and treatments, it can add years to their lives. But only some Americans can count on it. We can still change that: https://t.co/1DSnNEPwYb https://t.co/XbqvIZjB8p— Atul Gawande (@Atul_Gawande) February 6, 2018
--Here are a few more stories from The Post and beyond:
- The Senate Veterans Affairs Committee holds a hearing on pending legislation.
- The Senate Health, Education, Labor and Pensions Committee holds an hearing on the opioid crisis on Thursday.
- George Mason University’s Law and Economics Center holds an event on generic drugmakers on Friday.
Kaiser Health News holds a discussion on living well with dementia on Feb. 13.
How can Congress avoid another government shutdown?:
Trump wanted a parade. He just might get one:
Watch Jimmy Kimmel on Apple's move to add medical records to iPhones: