Essential health benefits discussion draws criticism

With less than two years before individuals and employers choose new coverage plans as directed by the Affordable Care Act, local legislators are trying to wade through federal mechanics of mandated coverage and how new required services will impact health care costs.

One step along the process is creating packages that include a list of 10 essential health benefits. These EHBs must include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse treatment; prescription drugs; habilitative and rehabilitative services and devices; laboratory services; preventive and wellness services, including chronic disease management; and pediatric care that includes oral and vision care. Many current policies don’t include such services, such as pediatric oral and vision care.

Dr. James Golden, Department of Human Services’ deputy assistant commissioner, told the House Health and Human Services Reform Committee Feb. 8 that Minnesota will be expected to adopt a “benchmark plan” that would serve as a floor for health care coverage. If a state chooses not to select one of four federal benchmark health plans, the state’s benchmark plan will become the largest plan by enrollment in the largest product within the state’s small group market.

Amy Monahan, a University of Minnesota Law School associate professor, said the benchmark package should cover the 10 categories, but not every service available within each category is required coverage. Monahan was one of 18 people nationally who studied and developed policy, criteria and methods for defining and updating the EHB.  

The initial package should be developed with cost targets, such as a national average premium, she said. Think of grocery shopping. Rather than going down the aisles and putting products in your cart, only to find out you can’t afford to pay the total amount at checkout, “It would be better to shop with a budget,” and selectively make tradeoffs, as difficult as those choices might be, she said.

Republican committee members were critical of the federal EHB process, which is proposed in a Dec. 16, 2011, Essential Health Benefits Bulletin published by the Center for Consumer Information and Insurance Oversight.

“This is an unproven experiment with no guarantee of medical results,” said Rep. Glenn Gruenhagen (R-Glencoe).

Rep. Tina Liebling (DFL-Rochester) said although she is not “totally sold” that the Affordable Care Act is the future of health care, a lot of other countries successfully offer government-run health care. Rep. Mary Kiffmeyer (R-Big Lake) replied, “Be careful about other countries as role models. Many of them are going bankrupt.”

Susan Hegarty