The Department of Health and Human Services held a listening session today in order to hear various stakeholders’ input on the Minimum Essential Health Benefits package, the provision of the Affordable Care Act that protect consumers from incomprehensive health insurance. The EHB package is a critical part of the Affordable Care Act, it requires that insurance plans in the small group and individual markets cover all essential health benefits so that consumers no longer pay for coverage then find that their benefits don’t cover them when they get sick, and that consumers no longer face bankruptcy or medical debt due to uncovered medical care. This was the l0th of 10 listening sessions held by HHS across the country to provide the public and opportunity to provide input as HHS formulates their regulations on EHB.
HHS Region 9 Director Herb Schultz kicked off the session by framing the discussion around 3 overarching themes that the regulations will define:
* What is the process for defining the minimum essential health benefits package?
* How to account for needs of diverse populations?
* What will the process for updating the definition be?
Nancy De Lew, a key HHS staff person who has helped to facilitate other listening sessions summarized some of the comments heard elsewhere, and asked those testifying to answer a number of questions that HHS is grappling with:
* Where should the final regulations fall on the continuum of comprehensiveness vs affordability?
* Where should we land on the continuum of specificity (as related to specific rare conditions)?
* ACA directs HHS to look at “typical employer based coverage”, should large group or small group plans be used as this reference point?
* How should HHS weigh uniformity vs state flexibility?
Over 120 people attended the listening session by conference call and over 150 individuals attended in person to testify. Various advocates from disease groups and provider groups spoke in support of services specific to their constituencies. Many individuals spoke on behalf of prevention, treatment, primary care, and disease management as a means of saving money that would otherwise be spent on later more acute care.
Some of our colleagues at NHeLP and other organizations testified that the language of the ACA specifies that the Secretary of Health and Human Services alone has the authority to determine the minimum essential health benefits package, allowing state flexibility would mean that the promise of health reform would not be realized for many individuals based only on the state they live in. Additionally, some argued that basing the package on what is currently typically covered in the small group market would be problematic because those plans generally have more limited benefits and networks, and this would set the bar too low moving forward. Others testified that even using large group plans as the model might not represent significant reform, and Medicaid and other federal programs should be used as models.
Health Access testified that HHS should consider using Knox-Keene (plus prescription drugs) as a standard for developing the EHB definitions. Knox-Keene currently protects most Californians from underinsurance, this standard has worked for 35 years, and if HHS develops standards less stringent than Knox-Keene, though not perfect, these protections that 20 million Californians currently enjoy may be compromised. One of the intentions of the EHB is to relieve consumers from fear of the fine print that often thwart health insurance consumers, to that end the EHB standard can not include caps and limits. Another concern related to the IOM recommendations is that it didn’t explore the multi-dimensional nature of affordability – in addition to premiums, out of pocket costs must be considered in order to ensure that insurers do not simply shift costs to beneficiaries through that channel. Additionally, we are concerned that cost targets on the benefit side would also result in cost shift to consumers. Finally, we suggested looking at the Independent Medical Review process currently used in California, as well as CHBRP which currently reviews mandate proposals, be considered as models in developing mechanisms for constantly evolving the definition of essential benefits.
Schultz emphasized that this is not the only opportunity to comment. Comments will be accepted in writing or through meetings with HHS Region 9 staff before regulations are released, during the regulation comment period, and afterwards. Schultz can be reached by phone at 415-265-7049 or by email at firstname.lastname@example.org. Comments can be emailed to Region9ORD@hhs.gov.