Filed Under:Health Insurance, Individual Health

More states post essential health benefits letters

(AP Photo/Denis Poroy)
(AP Photo/Denis Poroy)

More states have been posting essential health benefits (EHB) announcements on the Web.

States that generally back implementation of the Patient Protection and Affordable Care Act of 2010 (PPACA), such as New York and Hawaii, have been sending detailed recommendations to the U.S. Department of Health and Human Services (HHS).

States that have been active in opposing PPACA have posted letters giving reasons for declining to select EHB packages.

PPACA calls for state and federal agencies to set up exchanges, or Web-based health insurance supermarkets, by 2014, and for the plans sold through the exchanges to offer packages of benefits based on the EHB benchmarks, to ensure that consumers get comprehensive coverage, help them with apples-to-apples comparisons, and discourage insurers from watering down benefits.

HHS officials are letting states express their EHB preferences. EHB preference announcements were due Sunday. HHS has said that it will choose a benchmark plan for states that fail to recommend their own benchmark preferences.

In New York, for example, Donna Frescatore, executive director of the New York State Health Benefit Exchange, has written to the Center for Consumer Information and Insurance Oversight (CCIIO), the HHS arm responsible for PPACA implementation, to say her state will be using the largest small group plan in the state, Oxford EPO, to be the benchmark plan.

New York wants to beef up the pediatric dental and vision benefits the small group plan provides by adding the kinds of pediatric dental and vision benefits now available through the state's Children's Health Insurance Plan coverage, and it wants to offer "habilitative services," or services for people with autism and other developmental problems, that are comparable to the kinds of rehabilitative services that an insurer might cover for an individual who had had a stroke.

Officials in Alabama, Pennsylvania and West Virginia have declined to select an EHB benchmark, arguing that HHS officials have failed to answer their questions about the EHB program.

In Alabama, for example, Gov. Robert Bentley, R, wrote to Kathleen Sebelius, the HHS commissioner, that he is a "staunch opponent of the Affordable Care Act.”

Bentley, a physician, said he also believes HHS has asked states to select benchmark plans without providing clear guidance.

PPACA should work to control costs by encouraging use of health savings accounts, Bentley said.

Today, "the parameters placed on the selection of the essential health benefits benchmark plan do not allow states to select innovative mechanisms, such as health savings accounts, or a variation thereof,” Bentley said.  “As such, I decline to make a decision on the essential health benefits benchmark plan There is simply not enough valid information available now to make an informed choice for such an important decision.”

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