The 523-page final rule from the U.S. Department of Health and Human Services allows states to develop their own version of essential health benefits, starting in 2020. State officials will still have to offer the 10 essential health benefits established by the ACA -- including coverage for maternity care and mental health services -- but they’ll be able to pick and choose new benchmarks -- such as fewer covered doctors visits or prescription drugs -- for those services.
Under the current rules adopted by the Obama administration, states have one benchmark plan that defines how essential health benefits are covered in every plan.
The new rule also lets states loosen regulations on insurers' spending. The ACA required insurers to spend 80 percent of their profits on patient health care and quality improvement. Starting in 2020, states can request permission from the feds to allow insurers to spend more on their overhead costs -- like travel expenses and salaries -- if officials can prove it will stabilize premiums.
This is all in an effort to reduce premiums, which have risen sharply in recent years. Premiums rose 34 percent on average this year from 2017, and in 2017, they jumped 25 percent from 2016 rates.
