Allowing states to opt-out of Essential Health Benefits not only means a trend towards skimpier insurance plans (which is a de facto version of pre-existing conditions discrimination, if a plan is not available for you that covers the services needed for your pre-existing conditions). It introduces the return of annual and lifetime caps, since those bans under the ACA are based on what’s required to be covered under a fully functional Essential Health Benefits package. If a state, for instance, chooses to exclude prescription drug coverage under its EHB requirements, insurers can impose limits on those services.Loss of pre-existing condition coverage and renewal of caps on coverage are, effectively, death sentences from some chronically ill people.
And this potential effect goes beyond the individual market. Due to some quirks in the regulatory language surrounding the Affordable Care Act, if just one state anywhere scales back their EHBs, employer plans everywhere will be at risk for the return of lifetime and annual caps, and higher cost-sharing.
The spending growth rates for the proposed Medicaid per capita caps are "insufficient and unworkable," the directors wrote in a statement to be released Monday. While they say they support some elements included in the bill, "no amount of administrative or regulatory flexibility can compensate for the federal spending reductions that would occur as a result of this bill."