Dec 19, 2011

HHS To Give States "Broad Latitude" On Healthcare Benefit Standards

Posted by: Neal Stehly

The Washington Post (12/17, Aizenman) reported that HHS "will give states broad latitude to define the minimum benefits that many health insurance policies will be required to offer under the 2010 healthcare law, officials announced Friday." The plan "sparked criticism from interest groups on all sides of the issue. Consumer advocates worried that millions of Americans could end up with insurance substantially less comprehensive than the law's drafters intended," while "employers and insurers warned of an opposite scenario: A state could make the benefits package so comprehensive that the resulting plans would be prohibitively expensive." The law "leaves it to the discretion" of HHS Secretary Sebelius "to determine whether to specify precisely which procedures and services should be covered and to what extent insurers can limit the frequency of their use."

        The New York Times (12/17, Pear, Subscription Publication) said Friday's decision "would allow significant variations in benefits from state to state, much like the current differences in state Medicaid programs and the Children's Health Insurance Program." The Wall Street Journal (12/17, Radnofsky, Subscription Publication) reports Sebelius said, "As we've acknowledged many times, coverage that works in Florida may not work in Nebraska."

        The AP (12/19) reports that the law's requirement that the federal government "set a basic benefits package for private insurance" is "tricky territory for the administration as it tries to avoid the 'big brother' label on health care." But the proposal Friday from HHS Secretary Kathleen Sebelius "allows states to retain some leeway," for example letting each state "pick a benefits package from several federally approved options." Sebelius said, "The proposal we're putting forward today reflects our commitment to giving states the flexibility they need." According to the AP, "initial state reaction was positive."

        Politico (12/19, Millman) reports the HHS guidance "would ensure that families and small businesses who buy their own coverage have access to health plans that offer comprehensive, affordable benefits," HHS Secretary Kathleen Sebelius said on Friday. "At the same time, we want to give the states the flexibility to choose an essential health benefits package right for them."

        Bloomberg News (12/17, Wayne) also quoted Secretary Sebelius as saying, "Our approach will protect consumers and give states the flexibility to design coverage options that meet their unique needs." According to Neil Trautwein of the National Retail Federation, "lobbyists will focus efforts on trying to persuade states to adopt narrow packages of required benefits." Trautwein noted that the decision "shifts the argument back to the state arena where insurance has always been regulated."

        CQ Healthbeat (12/17, Bristol, Subscription Publication) quoted HHS Assistant Secretary for Planning and Evaluation Sherry Glied as saying that the approach "recognizes that issuers make a holistic approach in constructing a package of benefits" that "balance consumer needs for comprehensiveness and affordability." Some groups, however, were unenthusiastic about the decision. Carl Schmid of The AIDS Institute said, "We were looking for some federal protections, for a federal floor to the benefit design. It looks like we're not going to get that and we're still going to get the state patchwork of care." Schmid added that HHS had "also failed to provide any guidance on copays, deductibles and premiums, 'which is important, extremely important.'"

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