U.S. issues final word on essential benefits under 'Obamacare'
The Obama administration on Wednesday issued its long-awaited final rule on what states and insurers must do to provide the essential health benefits required in the individual and small-group market beginning in 2014 under the healthcare reform law.
A cornerstone of President Barack Obama's plan to enhance the breadth of healthcare coverage in the United States, the mandate allows the 50 U.S. states a role in identifying benefit requirements and grants insurers a phased-in accreditation process for plans sold on federal healthcare exchanges.
Wednesday's rule included few changes from previous administration proposals, a fact that could help states and insurers as they prepare for new online state health insurance marketplaces, known as healthcare exchanges, scheduled to begin enrolling beneficiaries for federally subsidized coverage on Oct. 1.
"The administration has been consistent in its approach to essential health benefits for more than a year, and that continued today. It's good news for states and insurers because it means they don't have to make any changes," said Ian Spatz, a senior healthcare adviser at the consulting firm Manatt Health Solutions.
The exchanges are expected to cover as many as 26 million people within 10 years and seem likely to dominate individual and small-group insurance markets. Another 12 million people are expected to receive healthcare coverage through an expansion of the Medicaid program for the poor, according to the nonpartisan Congressional Budget Office.
Obama's Patient Protection and Affordable Care Act sets out 10 benefit categories that must be covered by most plans at the same level as a typical employer plan. The categories range from hospitalization, prescription drugs and maternity and newborn care.
The American Cancer Society Cancer Action Network was cautious in its praise, describing the rule's prescription drug mandate as an improvement but warning that it was unclear whether patients would have timely access to drugs needed to treat and survive serious illnesses including cancer.
The rule got a cool reception from insurance and employer groups, which warned that higher costs could result from the new coverage requirements.
"The minimum essential health benefits standard will still require many individuals and small businesses to purchase coverage that is more comprehensive and more expensive than they choose to purchase today," said America's Health Insurance Plans President Karen Ignagni.