Essential Health Benefits – Last Call?
September 30 is upon us. Has your state e-filed their Essential Health Benefits (EHB) plan?
The ACA requires that all new, non-grandfathered plans in the individual and small group markets both inside and outside the Exchange offer a standard package of benefits. The EHB requires a balancing of benefits across 10 categories of care and by statute, prohibits discrimination based on health statues, age or disability.
Health and Human Services requested that states submit their EHB plans by September 30. In preparation, HHS set up a data entry tool for states to submit their selection, including the ability to fill the gaps or ‘supplement’ benefits where necessary. Fortunately, most states are being responsive. EHB activity ticked up during the month of August as the requested deadline neared. In August, many states announced public hearings on EHB or announced intent to choose an EHB plan. While most states are leaning toward a default selection – the state’s largest small group health insurance plan – the measure of success for consumer advocates is in the process.
Consumer Inclusion: Mixed Reviews. Most states have struggled with how to select their EHB. Do they choose a plan based on projected cost (or premium impact as the consultants call it), desired benefits, or whether or not it includes state mandates? The answer is yes – states are trying to contemplate all these demands – cost, coverage, and robustness.
Many states hired consultants, created advisory boards or committees, or attempted to analyze the data internally. The end result was most often a recommended plan to the Governor or Legislature with a public comment period for consumers.
In some states the process was robust. Oregon, for example, held a series of public feedback sessions and included consumer advocates in the process. Other states were less interactive with consumers. In Michigan, consumers had 14 days to comment on a recommended plan and there was no consumer representation in the selection process. In some states, consumer advocates had no opportunity to comment and have to wait for the federal comment period that will follow HHS’ release of proposed EHB state plans – hopefully before the end of the year.
While the process was less than ideal in some states, consumer advocates were successful in elevating their voice and their concerns. For example, Michigan leveraged its diverse coalition to provide comments in the short time period and highlight to the Insurance Department that a more robust process for consumers is necessary. Hopefully, over time, Insurance Departments will recognize the need to be more inclusive and that consumer engagement is vital to their success.
Consumer advocates should continue to offer their skills to support under-resourced Insurance Departments juggling a new set of tasks.
Monitoring forward. Michael Cannon of the CATO Institute recently wrote a blog instructing states to obstruct the EHB process by choosing plans that purposely omit required categories of care. These may include substance use disorder benefits or habilitative services. This verbal ‘I won’t do what you tell me’ goes well beyond my 4 year old’s tantrums. Cannon wants states to test the resolve of HHS. We are betting on HHS to uphold federal law.
This obstructionist behavior highlights the need for a robust monitoring process post September 30. The ACA provides us with some required oversight for tweaking of the EHB. For example, it instructs the Secretary to undertake an annual review of the benchmark plans. But continuing to advocate for a transparent process, reminding the Secretary of her statutory duties and the supporting the state in its responsibilities to its consumers is paramount.
The role of consumer advocates moving forward is to not just be expert advisors but also be the keeper of stories. Stories that both illustrate the gaps in EHB coverage and the success of coverage will be highly relevant when additional opportunities for comment and feedback arise following the initial roll out in 2014. Setting up the EHB feedback loop starts now.
— Eva Marie Stahl, Policy Analyst