Trump Rule Opens Door for Inadequate Coverage of Essential Services
Washington – Trump’s Department of Health & Human Services finalized a new regulation that will further erode affordable coverage, and protections provided by the Affordable Care Act (ACA).
HHS’s Notice of Benefit and Payment Parameters for 2019 final rule, issued yesterday, includes some of the biggest changes to the Essential Health Benefits (EHB) standard to date. The rule lowers the threshold of covered services required by the ACA and leaves consumers without the health care they need. As a result, insurers will be permitted to create much less comprehensive health plans with higher out-pocket expenses.
“The Trump administration is attempting to repeal through regulations core consumer protections established by the Affordable Care Act,” said National Health Law Program Senior Attorney Wayne Turner. “The new regulations actually limit state flexibility by penalizing states that wish to provide more generous benefit packages, while enabling cuts to essential health benefits like hospitalization, mental health and substance use disorder services, and maternal and newborn care.”
Staff Attorney Candace Gibson said, “The HHS rule guts EHB standards, which have provided low-income women with comprehensive health care that has further led to their economic security. Before the ACA, many women in low-income jobs had no access to comprehensive reproductive care, including maternity care services. The ACA was intended to stop insurance companies from discriminating against women in health care as well as those individuals with pre-existing conditions. HHS’ final rule will leave many women and their families without the care they need when they need it.”
National Health Law Program Staff Attorney Héctor Hernández-Delgado said HHS’ final rule will jeopardize adequate coverage of the EHBs and subject enrollees to medical debt for services that are no longer covered.
“The ACA requires Marketplace health plans to mirror coverage typically provided by employers,” Hernández-Delgado said. “HHS’ rule lowers the threshold for essential care by allowing large employer-plans to be regarded as ‘typical’ coverage without considering how benefits are covered across multiple employer-plans. Trump was unable to push a repeal of the ACA through Congress, but with this rule the administration will open the door to Marketplace plans with skimpier benefits and higher out-of-pocket costs. This represents yet another effort to sabotage the protections afforded by the ACA.”
The regulation also limits help for people trying to compare and sign up for health care plans by reducing the numbers of navigators, who have been advocates for patients, helping them to find and enroll in the best plans for their needs. The Trump regulation will introduce more bureaucracy into the navigation process, making it onerous for low-income people to enroll in an ACA plan.
See this letter from National Health Law Program and FamiliesUSA sent to HHS urging it “to protect the coverage gains made under the ACA that have made it possible for consumers to access a wide range of benefits and secure the health care they need in 2019 and beyond.”
Please contact National Health Law Program’s communications department at [email protected] or 202-552-5176 to speak with Turner, Gibson, and Hernández-Delgado for additional comments and resources.
NHeLP, founded in 1969, advocates for the rights of low-income and underserved people to access quality health care.