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Fla. Consumer Advocate Makes PPACA Essential Health Benefits Plea

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TALLAHASSEE, Fla. (AP) — A consumer advocate urged Florida insurance officials on Thursday to seek public comment on essential health care benefits under the federal Patient Protection and Affordable Care Act (PPACA).

Laura Goodhue, the consumer representative on the Florida Health Insurance Industry Advisory Board, made her appeal at a meeting of the panel, which focused on other aspects of PPACA following a U.S. Supreme Court ruling that upheld the law.

PPACA calls for regulators and others to use essential health benefits (EHB) packages as a benchmarks for calculating how much actuarial value a plan might provide. The U.S. Department of Health and Human Services says it likely will encourage states to develop their own EHB benchmarks based on the benefits packages available in typical health plans sold in those states.

The advisory board, made up mainly of insurance industry and business representatives, did not take public testimony on the PPACA EHB provision, but the state has received some written comments and will keep the record open so more can be submitted, said Deputy Insurance Commissioner Michelle Robleto.

States have the flexibility to implement essential health benefits under the law beginning in 2014. An EHB package is supposed to include benefits for hospitalization, prescription drugs, mental health, maternity and newborn care and emergency services.

Goodhue, executive director of Florida CHAIN, a health advocacy organization, said patients, providers and employers should have a role in making those decisions.

“It really should be made with public input and not unilaterally and not behind closed doors,” Goodhue said.

Plans to accept comment are fine, but the state should first advance some proposals so the public can react to them, she said. Goodhue acknowledged federal officials have yet to issue formal regulations on the essential benefits, but she said they have provided enough informal guidance for the state to begin developing proposals.

Gov. Rick Scott, R, a PPACA opponent, has announced he doesn’t intend to expand the state-federal Medicaid program for low-income and disabled patients. The Supreme Court ruled the federal government cannot force the states to implement that part of PPACA by taking away existing Medicaid funding allocations.

The board also heard from representatives of a private health insurance industry group, a state agency that oversees Florida’s Medicaid program, and the Heritage Foundation.

Some comments concerned what might happen if Obama is defeated and Republicans regain control of the Senate in the November election.

Edmund Haislmaier, a senior research fellow for the Heritage Foundation, predicted many employers will drop health benefits if PPACA stays on the books.

Some PPACA provisions already have gone into effect, such as provisions that require insurers to cover children’s pre-existing conditions.

A provision that would require most people to have a minimum level of health insurance coverage is set to take effect in 2014.

“We’re going to see fewer products and fewer options, which I don’t think is good ultimately for Floridians,” the board’s chairman, Insurance Commissioner Kevin McCarty, said after the meeting.