Essential Health Benefits Bulletin Draws Fire

Margaret Dick Tocknell, for HealthLeaders Media , February 7, 2012

It will also be essential for an appeals process to be established in every state, through the state department of insurance or other appropriate agency, regarding the coverage of EHBs to ensure fair and non-discriminatory practices."

The comment letter from the American Academy of Pediatrics and 13 other organizations involved in children's health expresses concern that the EHB bulletin doesn't address children's health issues as intended by the ACA. "Nine of the 10 potential benchmark plans are defined by their availability to employees, and the tenth, the largest HMO option, is also likely to be mostly employer-based.

Because these plans are built around working adult, they may lack important benefits for children." The letter notes that the ACA also requires that child-only plans be available in state exchanges but "the bulletin does not mention these plans."

The Essential Health Benefits Coalition, which consists of groups representing large and small employers such as the U.S. Chamber of Commerce and the National Federation of Independent Business, stresses cost and medical effectiveness in its comments. It also asks HHS to grant employers the same flexibility as states to "design and choose health coverage in a competitive marketplace that is most affordable for them and their employees."

EHBC recommends that only benefits in effect as of March 1, 2012 should be allowed to be considered for the benchmark EHB package and that new state benefit mandates not be added retroactively. 

The Pharmaceutical Care Management Association says it is happy with the EHB bulletin. "PCMA is encouraged that the HHS bulletin notes that EHB plans will have some design flexibility on pharmacy benefits and other issues. PCMA hopes that as HHS moves forward with regulations, it recognizes that relying on a market-based approach used successfully in the commercial market allows for greater flexibility and innovation."

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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