The call from the Department of Health and Human Services (HHS) for response to Essential Health Benefits guidance has resulted in an avalanche of comments from organizations such as the American Cancer Society, the American Medical Association and even House Democrats. A panel assembled by the Alliance for Health Reform and the Commonwealth Fund released a report last week addressing some uncertainties faced by states regarding Essential Health Benefits:
• No “common language” between insurance companies and across states regarding benefits. The language used to describe things like maternity care, rehabilitative services and more, varies widely from plan to plan and state to state. In most states there is no structure in place for standardizing how benefits are defined.
• Considerable cost disparity between benchmark plans. The panel used Colorado as an example, citing annual deductibles in the top three small group plans, which range from $350 to $1500. Benchmark plans are supposed to be used to set state standards, but such wide disparities make it a challenge to find a common price point.
• Existing state mandates for health insurance. Many states have specific mandates for coverage including tobacco cessation, oral cancer treatments and more. Under the Patient Protection and Affordable Care Act (PPACA) states must pay for any mandated coverage that falls outside the 10 Essential Health Benefit areas they have defined. This could place a large financial burden on states which mandate particular types of coverage.
While these questions need to be answered as states progress with Health Insurance Exchange development, HHS has issued statements saying that they will be flexible and will defer to states for the final decision regarding Essential Benefits.
