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The Trump administration took additional steps to weaken Obamacare on Monday, allowing U.S. states to relax the rules on what insurers must cover and giving states more power to regulate their individual insurance markets. The Centers for Medicare and Medicaid Services issued a final rule that allows states to select essential health benefits that must be covered by individual insurance plans sold under former President Barack Obama's healthcare law. The 2010 Affordable Care Act requires coverage of 10 benefits, including maternity and newborn care and prescription drugs. Under the new rule, states can select from a much larger list which benefits insurers must cover. (Abutaleb, 4/9)

The rules add two broad exemptions from the ACA’s requirement that most consumers be insured. The change offers escape hatches that will be retroactive two years, even before a recent tax law ends the penalties completely starting in 2019. People living in areas where only one insurer is selling plans in the marketplace now can qualify for a “hardship exemption.” So can people who oppose abortion and live in places where the only available plan covers abortion services. Federal health officials and private researchers have shown that about half of U.S. counties have only one ACA insurer this year. (Goldstein, 4/9)

The administration is also stepping up eligibility checks to make sure people are supposed to receive financial assistance under the law. Officials said they worried some low-income people in states that have not expanded Medicaid were overestimating their income, so that it becomes over the poverty level, thereby qualifying them for tax credits to help afford premiums on the law’s private marketplaces. (Sullivan, 4/9)

Object to abortion? You may be able to get an exemption from the Affordable Care Act tax penalty for people who don't get health insurance. The Centers for Medicare and Medicaid Services announced final rules Monday for the ACA's health insurance marketplaces, and expanded exemptions were part of the package. Last year's GOP tax bill repealed the health law's unpopular requirement to carry health insurance or risk fines from the IRS — but that doesn't happen until next year. (Alonso-Zaldivar, 4/9)

Democrats and some consumer groups denounced the rule as another effort by the administration to undermine the ACA. They have said that weakening the scope of the benefits offered in ACA plans will hurt consumers by reducing coverage. The new rule will “undermine protections for people with pre-existing conditions with a race-to-the-bottom approach that fundamentally undermines the Affordable Care Act’s essential health-benefit coverage guarantee,” said Brad Woodhouse, campaign director of Protect Our Care, a group that is an advocate for the ACA. (Armour, 4/9)

Health insurers have anxiously been waiting for the rule, which is usually released in mid-March. It follows on the heels of other actions taken by the Trump administration aimed at easing Affordable Care Act regulations in the name of promoting consumer choice, including a proposal to extend the duration of short-term medical plans and expanding access to association health plans that don't comply with ACA consumer protections. (Livingston and Luthi, 4/9)

CMS Administrator Seema Verma touted the changes as a way of increasing access and reducing premiums for consumers under the health care law. But she also stressed that it was simply an option, not a requirement. “These are just options for states,” she told reporters Monday. “If they don’t want to do this, they can stick with what they have.” (Clason, 4/9)