Essential benefits, health exchanges trigger questions, answers

Feb 22 2012

Today's headlines include a range of stories about the implementation of the health law and related policy developments.

CQ HealthBeat: Questions on Essential Health Benefits? CMS Has Some Answers
The Centers for Medicare and Medicaid Services published a fact sheet Friday that deals with questions that have been raised by states, patient groups and others about how states should develop their essential health benefits packages. A bulletin unveiled by CMS in December gave flexibility to the states to select among various existing plans as models for their benefits packages, which will be offered in individual and small-group insurance plans in state exchanges (Norman, 2/17).

Politico Pro: Mixed Messages On Federal Exchanges Funds
The Obama administration might have handed Congress a guide to defunding a key part of the health care reform law -; without taking away a penny that the administration already has at its disposal. Without doing anything at all, in fact. The president's fiscal 2013 budget requests an additional $864 million to build the federal health insurance exchange, which will operate in states that don't set up these new insurance markets on their own by 2014. Precisely how many states that will include is still an open question. The budget request caught many observers by surprise -; especially Republican critics who suspected all along that the administration had lowballed estimates. HHS had long maintained that an earlier $1 billion appropriation in the health care law would be enough to set up a federal exchange and pay for other implementation tasks (Feder, 2/21).

JAMA: Daunting Challenges for Creating, Implementing Health Reform Law's Insurance Exchange Program
One of the considerable challenges presented by the Affordable Care Act (ACA) is implementing the insurance exchange program required by the ACA, agreed a panel of state insurance regulators gathered earlier this week at the AcademyHealth Health Policy Conference in Washington, DC (Livingston, 2/17).

Also in the news -

The Philadelphia Inquirer: Drug Prices Too High Or Too Low?
Referring to the now nearly two-year-old health-care law, Sebelius said, "We didn't get as far as you are suggesting in terms of price controls, but we came some of that distance. It is illegal for us who run Medicare to negotiate for prices. As a former governor, I could negotiate for Medicaid prices and Medicaid drug prices are significantly lower than Medicare drug prices. But that is a change that has to be passed by Congress." Sebelius noted the donut hole problem in Medicare drug plans and that the administration's plan closed that by 50 percent right away and will change further (Sell, 2/17).

The Philadelphia Inquirer: Small Matters: Health Insurance A Big Headache For Small Firms
The government is going to decide the minimum that insurance carriers must provide in their coverage. And, the administration's spokesman said that the president wanted women to receive this preventive care/contraceptive benefit without having to pay anything to get it. But the cost of insurance will rise as regulators add more and more benefits like this one to the required package. About 40 percent of small firms (50 or fewer employees) offer some type of health-care benefit. Many plans will not qualify under the health law's requirements and will be dropped; others will be upgraded to meet the minimum, raising the cost of the insurance benefit that small-business owners must pay. Opting to offer no insurance still raises worker costs, and small firms will have to pay a "fine" for each worker not covered if the mandate begins in 2014, as planned (Dunkelberg, 2/20).

Reuters: Insurance Eligibility Improves Medical Care: Study
A new study suggests young adults are more likely to get care and see a doctor when states extend the time they can stay on their parents' health insurance -- a measure also mandated by the 2010 federal health care law. The laws are meant to help those over 18, who typically outgrow their parents' plans but have trouble getting full-time jobs with health coverage after high school (Seaman, 2/17).