Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Health Insurance > Health Insurance

On the Third Hand: Benefits

Your article was successfully shared with the contacts you provided.

Based on comments and private emails, I think about 60 percent of you hate the Patient Protection and Affordable Care Act (PPACA), 10 percent of you love it, and 30 percent just want to get through the day.

Even from the perspective of someone who feels a moderate level of hate for PPACA, I think that one of the nice things about the PPACA public health insurance exchange system and the PPACA “metal level” product classification system is that it makes having a conversation about what’s going on in the health insurance market a lot easier.

Whatever the many obvious and suspected faults with the federal government’s exchange “qualified health plan” application activity data, at least the U.S. Department of Health and Human Services (HHS) is giving me some numbers to write about.

EHealth Inc. (Nasdaq:EHTH), a Web broker, posted a fourth-quarter off-exchange health insurance price report based on its own sales in February.

Organizations like Mark Farrah Associates publish great commercial market enrollment and market share data after the quarter is over.

But HHS is posting a lot more data than I could normally get from the consulting firms.

What I’ve found, however, is that, even with the PPACA “essential health benefits” package rules and some states’ efforts to standardize plan design, figuring out what individual and small-group plans actually cover is still very difficult.

Example: A colleague wanted to write about mental health benefits a few months ago. I thought, “OK, that’s easy,” then scrounged around on website after website and realized I had no idea where to go to get even basic mental health benefits coverage details in any kind of format that I could figure out how to use.

On the one hand, someone could argue that gathering and publishing the market data the public exchanges purport to collect is difficult and expensive, and that the figures really don’t do much to improve the universe except to give reporters something to write about. 

On the other hand, I think one of the lessons of PPACA is that allowing silly, irritating problems with insurance to persist is a way to get Congress to drop 3,000-page legislative packages on your head.

The current difficulty patients have with finding out whether plans cover mental health counseling, accupuncture or abortion seems to be one of those silly, irritating problems.

To me, it seems as if getting an insurance industry group to come up with a standardized keyword system for describing the benefits a major medical plan offers would be a lot easier than facing the risk of the Democrats (or populist Republicans) imposing a federal benefits standardization mandate the next time they get the ability to move legislation through Congress.

On the third hand: Oh. I wrote about the possibility of the Democrats someday regaining the ability to move legislation through Congress. OK. Given how the PPACA exchange rollout is going, that may not happen until sometime after the stars fall out of the sky.

But I still think, as a consumer who reads standardized descriptions of hotel and passenger jet amenities, that it would be great for insurers to do a better job of describing what plans cover, out of the goodness of their hearts, even if, realistically, there’s not much of a risk of the U.S. government ever imposing another health insurance mandate in the next few millennia.

See also:


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.