... but experts say benefit flexibility may cause trouble
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