Business Groups, Consumer Advocates Draw Lines In The Sand About Essential Benefits
The essential health benefits (EHBs) countdown is on for 2016.
That鈥檚 when this provision of the Affordable Care Act, which sets out 聽that must be covered by plans sold on the exchanges, 聽by the Department of Health and Human Services. Business interests and consumer advocates are already making their positions clear —聽the former pushing for greater consciousness of premium costs and the latter looking to safeguard consumers鈥 coverage.
During a July 21 , members of the Affordable Health Benefits Coalition, a business interest group including the U.S. Chamber of Commerce and the National Retail Federation, said they would push to reshape essential benefits, arguing that current regulations have led to unaffordable hikes in insurance premiums.
requires plans cover emergency services, pre- and post-natal care, hospital and doctors鈥 services, and prescription drugs, among other things.聽The rule how specifically to interpret those categories.
鈥淲hat I hope is that they tear down the existing EHB and rebuild it from the bottom up,鈥 said Neil Trautwein, employee benefits policy counsel for the National Retail Federation, in an interview. Trautwein said the group would lobby both members of Congress and White House officials starting in 2015, in addition to making sure this issue is part of congressional candidate鈥檚 talking points in November鈥檚 midterm elections.
But consumer advocates will be working on a separate path聽in the months ahead.
Cheryl Fish-Parcham, private insurance program director for Families USA, told KHN that though the organization has not yet worked out details of its strategy, it will work alongside groups such as the National Women鈥檚 Law Center and the Georgetown Center for Children to make sure that most of the current health benefit requirements are maintained.
鈥淧eople need to be cautious about thinking of the cost of premiums without thinking about what you鈥檙e getting for the premiums,鈥 she said.
For instance, before federal regulations required plans to cover maternity care, people would purchase plans that didn鈥檛 cover pregnancy-related needs 鈥 often not realizing so until too late, she added. Similar situations also arose with plan purchasers who didn鈥檛 realize they would need coverage for mental health care or substance abuse, areas current EHB policy mandates be covered.
鈥淭hose really leave you up a creek,鈥 she said.
Meanwhile, Trautwein did not list benefits that should be cut, suggesting instead that groups such as the Institute of Medicine determine what is really essential. Insurance plans, he added, 鈥渁re perfectly capable鈥 of providing benefits without being required to do so through federal regulation.
鈥淭his may be a question of setting a budget for the package and then see how much fits in,鈥 he said, adding that premium cost 鈥渂ears revisiting.鈥
But looking too closely at premium cost could have other ramifications, Fish-Parcham said. For instance, regulations that lead to reduced premiums could result in higher deductibles, leaving plan users 鈥渧ery vulnerable.鈥
Instead of looking at cutting benefits themselves, she added, policymakers should look at cutting the overhead costs that go into each benefit 鈥 for instance, the costs of health care facilities or insurers鈥 administrative fees.
鈥淭here are a lot of areas to look at for cost control in the future,鈥 she said.