U.S. issues final word on essential benefits under 'Obamacare'
Neil Trautwein, National Retail Federation vice president, said the ultimate impact of the regulation will not be felt until plans are priced and sold on the market.
"The administration has tried hard to navigate between the competing concerns," he said. "But I'm worried that people won't be able to afford coverage."
Insurers including UnitedHealth Group Inc, Aetna Inc and Cigna Corp will use the government's final word on these required benefits as they design plans and set premium prices ahead of the exchange launches. They have each said they will sell plans on some of the exchanges, but have not yet committed to which ones.
UnitedHealth, the largest insurer, said it is still reviewing the new rule. The company said the exchange insurance plans will essentially be a new type of coverage.
"In the long term, we are expecting and preparing for an 'exchange' category of coverage to become established as a new benefit category between Medicaid and the traditional commercial benefits markets," spokesman Daryl Richard said.
The U.S. Department of Health and Human Services said the rule would mean greater access to mental health and substance abuse services by requiring parity with other healthcare benefits. HHS estimated that 62 million Americans would gain mental health coverage, an issue that has risen in importance after a string of mass shootings including last year's elementary school massacre in Newtown, Conn.
The final rule preserved the state role in determining how the requirements are met by selecting their own benchmarks from plans sold within their respective borders. Most states opted for their home market's largest small-group plan.
But after two years, HHS said it would review the situation and determine whether a new approach might be necessary.
The administration kept to the benchmark rule despite objections from consumer groups who claimed that some of the selected plans were not comprehensive enough and argued for a single, uniform federal package.
But HHS officials found that maintaining states as primary regulators of state insurance markets would keep benefit offerings more in line with services typically offered through employer-sponsored plans in each state.
"The states continue to maintain their traditional role in defining the scope of insurance benefits and may exercise that authority by selecting a plan that reflects the benefit priorities of that state," HHS said in the rule.
The administration also gave insurers the chance to phase-in requirements for plans sold on federally facilitated exchanges and denied requests from groups that wanted to exempt low-cost community health plans and Medicaid managed-care plans from the accreditation process.