Little-Noted Provision of GOP Health Bill Could Alter Employer Plans
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Source: WSJ
Last-minute amendment would allow states to obtain waivers from certain Affordable Care Act
Updated May 4, 2017 9:36 a.m. ET
Many people who obtain health insurance through their employers—about half of the country—could be at risk of losing protections that limit out-of-pocket costs for catastrophic illnesses, due to a little-noticed provision of the House Republican health-care bill to be considered Thursday, health-policy experts say.
The provision, part of a last-minute amendment, lets states obtain waivers from certain Affordable Care Act insurance regulations. Insurers in states that obtain the waivers could be freed from a regulation mandating that they cover 10 particular types of health services, among them maternity care, prescription drugs, mental health treatment and hospitalization.
That could also affect plans offered by large employers, health analysts said.
The ACA prevents employer plans from putting annual limits on the amount of care they will cover, and it bars lifetime limits on the 10 essential benefits. But in 2011, the Obama administration issued guidance stating that employers aren’t bound by the benefits mandated by their state and can pick from another state’s list of required benefits. That guidance was mostly meaningless because the ACA established a national set of essential benefits.
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Under the House bill, large employers could choose the benefit requirements from any state—including those that are allowed to lower their benchmarks under a waiver, health analysts said. By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation.................
Read more: https://www.wsj.com/articles/little-noted-provision-of-gop-health-bill-could-alter-employer-plans-1493890203
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From left, CMS Administrator Seema Verma, Vice President Mike Pence and Secretary of Health and Human Services Tom Price on Capitol Hill on Wednesday. Mr. Pence met with House Republicans to lobby for health-care legislation. Photo: Eric Thayer/Getty Images
By Stephanie Armour and
Michelle Hackman
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