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The Catch: Are You Essential?

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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.”

The EHB also should protect patients “from high cost-sharing and specialty tiers that can limit access to lifesaving care and treatment,” the groups say.

New York-Presbyterian Hospital has added to the campaign by using “I Am Essential” as the title for a video of its own about the value of the hospital’s support services staff. (See the video below.)

Wendell Potter, who was once a public relations executive at Cigna Corp., Bloomfield, Conn. (NYSE:CI), and now is a critic of the health insurance industry, has written in a recent article for PR Watch that the I Am Essential campaign drives home the point that a skimpy EHB package could dramatically expand the ranks of the underinsured.

“That would not only be a nightmare for many American citizens, but I’m betting for any politician who is on the record supporting ‘Obamacare,’”Potter says. “If people find out that the coverage they have to buy is of limited value to them when they get sick, they’re not going to be very inclined to vote for Democrats come 2016, especially if insurance firms continue their long-running streak of record-setting profits.”

Potter says he believes another EHB coalition — the Essential Health Benefits Coalition, which is encouraging HHS to emphasize affordability in EHB development efforts — is an example of “astroturfing,” or an industry group masquerading as a group representing the interests of consumers or small businesses.

The leaders of the U.S. House Energy and Commerce Committee have asked HHS Secretary Kathleen Sebelius about the department’s contract to pay $433 million for an experimental smallpox drug from Siga Technologies Inc., New York.
The smallpox virus appears to have been eradicated in the wild in 1978, and there are questions about whether the drug contract was awarded for political reasons, but some smallpox samples may remain in biological warfare laboratories.
Lawmakers are asking for HHS assessments of the smallpox threat. One

Guardian Life Insurance Company of America, New York, has come up with an interesting twist on vision benefits — a plan that gives vision plan enrollees a choice etween two different vision networks.

Employees can choose between the VSP Vision Care network and the Davis Vision network.

The dual-network option is available for new vision groups at employers with 100 or more employees.