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December 21, 2011 at 09:14 AM
The essential health benefits (EHB) is starting to heat up.
Group representing patients and others with an interest in specific conditions, such as AIDS, arthritis, diabetes and lupus, have united to launch a lobbying campaign billed as the “I Am Essential” campaign.
The groups want to make sure the U.S. Department of Health and Human Services (HHS) thinks about people with disabilities and with chronic health problems as it develops EHB standards, according to the AIDS Institute, Washington, one of the campaign participants.
HHS officials are developing the EHB standards to implement Section 1302(b) of the Patient Protection and Affordable Care Act of 2010 (PPACA). Congress added the section in an effort to help consumers shop for health coverage, keep plans from undercutting competitors by skimping on benefits, and to keep plans from using skimpy benefits to scare off consumers with health problems.
The Center for Consumer Information and Insurance Oversight (CCIIO), an HHS arm, recently pleased insurers, employers and some consumer groups by saying it will emphasize affordability as well as comprehensiveness and likely will mandate a standard benefits package comparable to what small employers now offer, rather than what large corporations provide.
The groups mounting the I Am Essential want the voice of patients to play a bigger role in the EHB debate, the groups say in a letter to HHS.
Focusing too much on affordability could result in less robust and inclusive coverage, the groups say.
The groups say the EHB should ensure that patients have “access to ample formularies of medicines that provide clinicians with a full range of choices that meet patient needs,” and that patients must be “protected from utilization management techniques which may penalize the chronically ill by limiting their access to care, medicines or treatment.”
