The essential health benefits (EHB) package — the big, scary edifice glowing like a politically radioactive potato at the heart of the Patient Protection and Affordable Care Act (PPACA) — is starting to heat up.
Starting in 2014, PPACA is set to require insured, non-grandfathered individual and small group medical plans to offer EHB package benefits, to help buyers shop for coverage on an apples-to-apples basis and discourage benefits-package-based antiselection.
Acupuncturists are fighting for acupuncture benefits.
Parents of children with developmental problems are fighting for rich benefits for children with developmental problems.
What Your Peers Are Reading
The Essential Health Benefits Coalition — a group that represents organizations such as America’s Health Insurance Plans, the Blue Cross and Blue Shield Association and the National Retail Federation –is trying, politely, to discuss the idea that, to keep coverage as affordable as possible, the EHB package ought to be as short and practical as possible.
If there’s any flexibility, it ought to help plans use any available cost-management tools, such as any available annual or lifetime benefits limits, reduce costs, the coalition told regulators in a comment letter sent to the U.S. Department of Health and Human Services (HHS) in December 2012.
HHS should not use any flexibility to give states more authority to heap ever more benefits mandates on plans, the coalition said.
The drafters of PPACA created a list of 10 categories of benefits an EHB ought to include, then left the rest of the politically sensitive EHB creation work to HHS.
HHS officials developed a list of types of plans that state regulators ought to look at when creating their states’ EHB packages, then handed the EHB work off to any state that was willing to take the potato.
Now, as HHS develops the final version of the EHB standards, and as state exchanges, the federal exchange program and insurers prepare to put the EHB standards into actual use, everyone is noticing that the radioactive EHB potato has creepy, radioactive, googly eyes.
The EHB package could determine if your sweet, wonderful 2-year-old who is not talking properly gets the therapy that, in your view, could determine whether that child ends up with the ability to live a typical life.
The package could also determine whether Jane Doe, the owner of Jane Doe’s Pancake House Restaurants, thinks the EHB package in the small group plan she is sponsoring is a good value, under the circumstances, or a jewel-encrusted rip-off that enriches quacks and leeches and threatens her ability to keep her chain of restaurants in business.
And it looks as if HHS, state regulators, patient advocates, and employers and insurers could end up going round and round in cycles of increasingly arcane tinkering with the EHB package.
On the one hand: This is obviously the situation you get yourself into when you substitute government control for the invisible hands of the market. The basic idea of the EHB package may be so reasonable and so necessary for having the kind of competitive, easy-to-understand, guaranteed-issue, mostly community-rated exchange system contemplated by the PPACA drafters that just about anyone other than a very pure free-market purist would have come up with the EHB idea.