Officials throughout the United States are facing an emotional battle over what residents believe ought to go into an “essential health benefits” (EHB) package.
The Tennessee Department of Commerce and Insurance has created a documentary snapshot of public opinion on the EHB package by posting 153 pages of comments on the topic.
In Tennessee, the commenters include health care providers, patients, caregivers, and members of the insurance and benefits communities.
The patients and caregivers are pleading for mercy.
Dr. David Buckman, who has a daughter who has a form of autism, asks policymakers to consider putting services that help people with autism cope with adult life in the EHB package.
Today, “there are few resources in our state to assist in these challenging areas for adults with autism,” Buckman says. “Right now they are pretty much ‘on their own,’ sink or swim, in our state. As family we are doing out best to help [our daughter] ‘swim’ but the going is pretty rough on our own.”
The members of the insurance and benefits communities are asking for help with costs and red tape.
C. Gregg Conroy, a human resources specialist, acknowledges in his letter that the individuals asking policymakers to include various conditions, treatments and drugs in the package have good intentions.
But, “my concern is that, however well-intentioned, these individuals and the organizations/interests they represent are looking through a narrow lens of coverage for their cause and are not considering the broader implications of the costs associated with including all of these suggested benefits,” Conroy says. “As a long-time employee benefits and human resources professional I am concerned that they are not considering the critical element of overall affordability as they support their focused interests.”
The EHB Program
The Tennessee department is developing EHB package standards to comply with the EHB provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).
If the law takes effect on schedule and works as drafters expect, it will require all individual and small group major medical plans to offer the standardized EHB package by 2014, to help consumers compare coverage and reduce gaps in coverage.
The U.S. Department of Health and Human Services (HHS) has asked each state to design its own EHB package.
A state is supposed to start by looking at the benefits offered by the three largest Federal Employee Health Benefits Program plans offered in the state, the three largest state employee benefit plans, the three largest small group commercial health plans, and the largest commercial health maintenance organization (HMO) plan.