The Trump sabotage of the Affordable Care Act continues with the annual release of guidance to state and insurers provided by the Centers for Medicare and Medicaid Services. Saying "Too many Americans are facing skyrocketing premiums that they can’t afford, and every year consumers are faced with the threat of fewer choices," CMS Administrator Seema Verma released the new guidance that will allow states and insurers to offer "choices" that provide skimpier coverage and less protections for people with pre-existing conditions. She added "Until the law changes, we won't stand idly by as Americans suffer." Because having informed choice in purchasing insurance that covers their needs is apparently suffering.
The ten essential health benefits will remain, but the rules give states much great leeway in defining them, and loosening what the required benefits will have to allow. For example, while plans will still have to offer benefits such as maternity care and mental-health services, they can do things like limit how many ultrasounds would be covered in maternity care, how many office visits would be allowed for therapy, or restrict the prescription drugs that are covered.
Andy Slavitt, who was acting CMS administrator during the Obama administration’s final two years, countered that the current administration "is making it clear that they're implementing a law that they have no intention of making succeed." Slavitt called the revisions "a gift to the insurance companies by finding lots of ways for them to get around the standards Americans have come to expect." […]
Dan Mendelson, president of the consultant Avalere Health, said the new direction "is significant because what the ACA did was create a national standard" and insurance protections for people who could not get affordable health benefits through a job. "Aspects of this rule . . . imply that national standard is going away."
Gone too is the requirement that insurers spend 80 percent of premiums collected on actual patient care, if they can demonstrate that spending less would make them more financially stable, a hurdle that's not likely to be very high in this administration. So it's not clear how much of any given customer's premiums are going to be spent on actually taking care of anyone in the pool.
The hits on consumers continue. Insurers will no longer be required to provide a standardized set of benefits, which allows people to comparison shop for coverage. CMS is also going to put the 39 states that use the federal exchange, Healthcare.gov, in charge of making sure that plans being sold in the marketplace have enough care providers in their networks. The new rules also limit the number of marketplace navigators required, the people tasked with helping customers get through the process of deciding on a plan. They will no longer require that there be at least two navigator groups—one of them local—for every marketplace area.
The new rules also include abortion because of course they do. You can now qualify from a "hardship exemption" from buying insurance if the only insurance plans available in your area provide abortion coverage and you don't think they should. But that exemption now also extends to people who have only one choice of insurer in their area, which is about half of U.S. counties. These exemptions are retroactive for two years, meaning if you qualify and didn't pay the individual mandate penalty in the past two years for not having purchased coverage, you won't have to. Note that the individual mandate still exists, on paper and without teeth. What was repealed in the tax law passed last year was the penalty side of it. So now people have added excuses to be able to refuse to buy insurance. Those excuses really aren't necessary, except for the retroactivity. But it does mean insurance companies considering participating in some markets will reconsider providing abortion coverage.
These changes are all about dismantling Obamacare and all about giving insurers the upper hand again. The insured pool will shrink in many areas, and because of that premiums will go up—probably even more than previously projected. Ironically, that will happen in an awful lot of Republican districts and right before the midterm election. This is shaping up to be another sabotage that could turn around and bite Trump on his fat ass.