DOL Report Flunks a Major Test

These days almost any healthcare news worthy of a Department of Health and Human Services press release proudly proclaims yet another terrific program that is cutting costs, improving safety, insuring more people, etc. etc.

Selected Medical Benefits: A Report from the Department of Labor to the Department of Health and Human Services should have been released with that type of fanfare. After all, there's a line in the Affordable Care Act that specifically requires the Secretary of Labor to "conduct a survey of employer-sponsored coverage to determine the benefits typically covered by employers, and to report the results of the survey to the Secretary of Health and Human Services."

This information will be used by HHS to help identify the essential health benefits that should be included in the health insurance plans scheduled to be offered by health insurance exchanges beginning in 2014. Insurers in the HIEs, and in the individual and small group markets, will be required to offer benefits consistent with what employers typically offer.

That sounds important to me, like the type of report HHS would want to make sure received press coverage. Maybe the information it contained wasn't quite up to the level of a conference call with Secretary Sebelius, but this baby didn't even rate a decent press release. Instead, HHS put out a 4-paragraph press release that thanked the DOL for the report and then went on to talk about how exciting it is that Institute of Medicine is working on its own set of essential health benefits.

With that kind of faint praise I could hardly wait to get my hands on the DOL report. It is 62 pages of tables, text and data, some rehashed from other reports and a lot of it from 2008, which is a lifetime ago in terms of the economy and healthcare.

There is some new information on 12 selected benefits: ambulance services, durable medical equipment, diabetes care management, ER visits, infertility treatments, kidney dialysis, maternity care, organ and tissue transplantation, physical therapy, prosthetics, gynecological exams and sterilization.

But here's the rub: for a report that's supposed to help guide decisions about what constitutes essential healthcare benefits, it's very light on what is actually covered. Part of the problem stems from the definition of "covered" used in the report, which requires that health plan documents specifically mention the service as covered to be counted as covered. If a service isn't mentioned its falls into the "not mentioned" category, which the report explains means the service may or may not be covered. Huh?

For six of the 12 benefits the "not mentioned" percentage is larger than the "covered" percentage. What does that tell anyone who is trying to justify identifying one benefit over another as essential? If you followed the logic of the DOL report you'd give ER visits the nod over diabetes care management.

In its short life, the report, which was released April 15^th, has collected its share of criticism. Trade groups and lobbyist have termed it "irrelevant" and "minimalist." There are complaints that the information is skewed toward the benefits offered by large employers and has little application to small employers and individuals.

In the DOL's defense I'll say that anyone who has ever tried to decipher their own health benefits plan knows that the documents are often less than clear. But you know what I do when I'm confused by my benefits? I pick up the phone and ask the benefits manager.

The DOL was charged with identifying benefits that are typically covered. It's an important piece of the healthcare puzzle and could affect coverage for years to come. Who knows, lives may even depend on the benefits selected.