... but ex­perts say ben­e­fit flex­i­bil­ity may cause trou­ble

Modern Healthcare - - EDITORIAL MODERN HEALTHCARE - Rich Daly

State-by-state flex­i­bil­ity on “es­sen­tial ben­e­fits” called prob­lem­atic

Con­fu­sion has given way to both un­der­stand­ing and con­cerns. In­di­ca­tions that HHS will al­low greater-than-ex­pected state-level cus­tomiza­tion of “es­sen­tial ben­e­fits” pack­ages of ser­vices in­sur­ers must cover un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act ini­tially took health pol­icy lead­ers by sur­prise last month.

But fur­ther re­flec- tion has led many to see both po­lit­i­cal ad­van­tages and pol­icy prob­lems stem­ming from a 50-state ap­proach.

In De­cem­ber guid­ance is­sued to gen­er­ate pub­lic feed­back, HHS wrote that its com­ing rules to im­ple­ment the highly an­tic­i­pated es­sen­tial ben­e­fits re­quire­ments will al­low states to se­lect from plans al­ready op­er­at­ing within their bor­ders. The re­form law re­quires

“We’re very con­cerned that the fed­eral govern­ment didn’t take the op­por­tu­nity to ad­vance the field of es­sen­tial ben­e­fits.”

—He­len Dar­ling, National Busi­ness Group on Health

all non-grand­fa­thered small-group and in­di­vid­ual in­sur­ance mar­ket plans na­tion­wide to cover a core group of ser­vices, known as an es­sen­tial ben­e­fits pack­age, start­ing in 2014.

HHS Sec­re­tary Kath­leen Se­be­lius said dur­ing a call with re­porters that the ap­proach aims to al­low states to tai­lor the es­sen­tial ben­e­fits pack­ages to the needs of their own res­i­dents. Those dif­fer­ing needs ap­pear to ref­er­ence the dif­fer­ent po­lit­i­cal en­vi­ron­ments in the states and not dif­fer­ent cov­er­age needs be­cause HHS of­fi­cials de­clined to ex­plain, when asked dur­ing the call, how the cov­er­age needs of peo­ple dif­fer based on the state in which they live.

The ap­proach drew praise from across the po­lit­i­cal spec­trum for dif­fus­ing a po­ten­tial pre-elec­tion po­lit­i­cal pow­der keg in­volv­ing the con­tro­ver­sial law.

“It makes it much harder to use that par­tic­u­lar piece as a light­ning rod, if you will, in a national po­lit­i­cal cam­paign if you have

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