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Last week the United States Department of Health and Human Services issued the Notice of Benefit and Payment Parameters for 2019 final rule. This final rule is another assault on the Affordable Care Act (ACA) and its benefit and coverage protections. The Center for Medicare Advocacy, working with other advocacy partners, submitted comments and signed-on to letters opposing the rule when it was first proposed. We opposed “changes to the Essential Health Benefits (EHBs) standard which would lower the threshold of covered services and leave many consumers without access to the health care they need.” Unfortunately, the final rule, among other things, does just that.

The ACA requires insurers to cover Essential Health Benefits, which include ambulatory services, emergency services, hospitalization, maternity care, mental health and substance abuse, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services. The weakening of these essential benefits through regulation will lead to more and more plans that provide little or no coverage for people when they get sick or injured. In addition to undermining EHB’s, the final rule also negatively impacts network adequacy, rate review, navigators and the Medical Loss Ratio.  

As if this weren’t harmful enough, on Monday April 23, 2018 comments are due for the Short-Term, Limited-Duration Insurance Proposed Rule. Often referred to, accurately, as “junk plans” or “fake insurance,” these plans offer insurance in name only, and would leave consumers without any real coverage when they need care the most. As we’ve highlighted over the last few months, this would also leave consumers who remain in the individual market – including those who are older or have pre-existing conditions – with higher costs. We encourage advocates to submit comments on the proposed rule. These plans will do nothing but undermine benefits, erode ACA coverage protections and further inflate costs.

These attempts by the Administration to undermine the ACA and sabotage our health care system must end. The American people deserve access to quality, comprehensive health coverage that will be there when they need it most.

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