The Truth About Essential Health Benefits

I'll admit it. I was skeptical of the administration punting essential health benefits to states. But I knew there had to be more than just politics involved. So, I attended the Alliance for Health Reform's briefing, Essential Health Benefits: Balancing Affordability and Adequacy, on the Hill last week to expand my knowledge.  Presenters included: John Santa, from Consumer Reports; Janet Trautwein, from the National Association for Health Underwriters; Chris Koller, Rhode Island health insurance commissioner; and Kavita Patel, from the Brookings Institution. It proved to be a very informative and enjoyable session. I won't go into the basics of essential health benefits here, because I want to focus on what was emphasized at the briefing.

3 interesting take-away points:

1) Adequacy and affordability will be the big advantages. The law requires precise, understandable benefit language; clear limits and exclusions; and everyday understandable key definitions to make it easier for consumers to make informed decisions about their health insurance. One hurdle still being worked out, in addition to affordability, are standard definitions. For example, habilitative care: what does this even mean?  Habilitative care refers to the acquisition of new skills, say for an autistic child, as opposed to rehabilitative care, which is a regaining of former skills. However, there is not an industry-wide agreement on exactly what habilitative care consists of.

2) Although punting to states and using benchmarks sounded like political strategy, it is not something new and is already the standard for state CHIP. It provides a relatively quick method to create qualified plans that must be offered by the 2014 deadline. This allows for state flexibility, which is very much appreciated according to Mr. Koller (R.I. commissioner of health citing states' already overwhelming work load). Additionally, almost every state already has insurance benefit mandates. (ex: mammograms). The problem is that state mandates do differ from state to state, and the obvious end result is non-uniformity. However, the good news is that there is considerable overlap in mandates, so states largely cover the same benefits (Janet Troutwein, National Association of Health Underwriters).

3) Contrary to popular belief, the legislative intent was to NOT be very prescriptive and set out stringent rules. The intent was to strike a balance and set a floor instead of a ceiling as a result of a failed, very prescriptive Clinton bill in the 90s (Kavita Patel). So punting to states wasn't last minute strategery after all.

I'm personally very excited that these insurance reforms are taking place. It's about time our country's healthcare got a facelift. Interested in more? Webcast of the event is now available online.