The Essential Health Benefits--Comments from Health and Disability Advocates

On December 16^th 2011, the Department of Health and Human Services released a much-anticipated bulletin on the Essential Health Benefits (EHB) package. Instead of containing information on what the package would contain, the bulletin deferred the task of defining EHB to each state. Supplementary information designed to clarify the approach taken in the bulletin was released on January 25, 2012.

Health & Disability Advocates, the organization which powers Illinois Health Matters, submitted their comments on these bulletins to HHS on January 31, 2012, reflecting specific concerns:

The role of the EHB package was to create a standard of health care covered by insurers for all Americans purchasing insurance through the state exchanges. This would mean a standard of adequate care for all, without discrimination due to age, gender, disability, chronic illness or geographical location.  It is the vehicle that would bring the goal of health care reform, that is, high-quality, comprehensive care, to many citizens.

The proposed plan gives states a vague benchmark system, with no federal oversight currently put in place, to use in defining the EHB. Although it is understandable for states to want flexibility in defining their EHB package, the degree of flexibility HHs is allowing could permit states the freedom to eliminate important benefits or the protection the EHB provides against insurance discrimination. Furthermore, to hand off all of the important decisions regarding the EHB package to the states goes against Congress’s intentions in the ACA of a federal standard, defined by HHS, for minimum coverage. As HDA states in their comments, “Simply said, the HHS EHB Bulletin is inadequate at best, and at worst, is an impediment to effective implementation” of health care reform.

HDA urges HHS to protect the potential of EHB plans by establishing an official, federal oversight process that involves a diverse range of perspectives, including those of people with disabilities and chronic illness. The HDA comments outline specific suggestions for the development of an EHB plan going forward that would safeguard the potential benefit of the EHB package, including the following:

•  Reflects an appropriate balance among the categories describes in such subsection, so that benefits are not unduly weighted toward any category
• Does not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life.
• Takes into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups
• Ensures that health benefits established as essential are not subject to denial to individuals on the basis of the individuals’ age or expected length of life or of the individuals’ present or predicted disability, degree or medical dependency, or quality of life.

To read the full list of HDA’s specific concerns, read the full comments here.

Barbara A. Otto

Chief Executive Officer

Health & Disability Advocates