Disability groups call for delay in “essential benefit’ rules

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A bulletin released by the Department of Health and Human Services in mid-December is raising concerns from disability advocacy groups that the administration is rushing its process for determining the minimum benefits all health insurers must provide as part of the Obama health care bill.

The Affordable Care Act laid out out 10 broad categories of benefits and services that all insurance companies must provide in order to be part of the new state-run health insurance exchanges, which are expected to be created by 2014. HHS was expected to create a detailed list of “essential benefits” that fit under the 10 categories, but, in a surprising move, the department announced December 16 that it would provide the state’s flexibility in determining which “essential benefits” the companies must provide.

“Under the Affordable Care Act, consumers and small businesses can be confident that the insurance plans they choose and purchase will cover a comprehensive and affordable set of health services,” said HHS Secretary Kathleen Sebelius in a December 16 news release.  “Our approach will protect consumers and give states the flexibility to design coverage options that meet their unique needs.”

The department’s public comment period for the proposal is open until Jan. 31. However, a coalition of 75 health care and disability advocacy groups sent a letter to HHS Secretary Kathleeen Sebelius on January 11 asking for the public comment period to be extended, in order to ensure that the states are not provided too much leeway and undermine the broad coverage goals of the Affordable Care Act.

“The design of the Essential Health Benefits will directly impact the scope of health benefits and the well-being of over 70 million patients. Beneficiaries affected will be those covered in non-grandfathered plans in the individual and small group markets, the Medicaid benchmark, and other Basic Health Programs,” the letter stated. “Basically, these benefit sets will have far reaching implications for our entire health system.  Weighing in on this decision is far too important to be done with anything less than careful and intensive deliberation.”

Though the proposal would allow the administration to deflect criticism that the Affordable Care Act provides too much coverage to the federal government in health care decisions, some Republicans in Congress have criticized the proposal as proof the administration is trying to cover up the true costs of the new regulations.

Under the Affordable Care Act, all insurers must provide ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care