Plans with­out hos­pi­tal cov­er­age face crit­i­cism

Modern Healthcare - - NEWS - By Bob Her­man

Pres­sure is build­ing for the Obama ad­min­is­tra­tion to dis­al­low em­ployer-based health plans that tech­ni­cally com­ply with the Pa­tient Pro­tec­tion and Af­ford­able Care Act but do not of­fer hos­pi­tal cov­er­age.

Sup­port­ers of the plans con­tend that such “skinny” plans are bet­ter than noth­ing for low-wage work­ers. But hos­pi­tal groups have slammed them. “I can’t even en­vi­sion this ad­min­is­tra­tion al­low­ing th­ese plans,” said Chip Kahn, CEO of the Fed­er­a­tion of Amer­i­can Hos­pi­tals, who pre­dicted a po­ten­tial con­sumer re­volt.

Some em­ploy­ers are us­ing the plans to avoid the re­form law’s penal­ties for com­pa­nies with 50 or more full-time work­ers that don’t of­fer af­ford­able cov­er­age. They have re­lied on a CMS-pro­vided cal­cu­la­tor spread­sheet al­low­ing them to de­sign ben­e­fits that are ac­tu­ar­i­ally equiv­a­lent to bronze-tier plans un­der the law. They’ve found they can do so with­out cov­er­ing in­pa­tient ser­vices.

“It wasn’t an in­ten­tion of the ac­tu­ar­ies who de­signed this to carve out hos­pi­tal­iza­tion,” said Anne Len­nan, pres­i­dent of the So­ci­ety of Pro­fes­sional Ben­e­fit Ad­min­is­tra­tors. “They were just be­ing good health ac­tu­ar­ies ad­her­ing to the law.”

Kevin Schlot­man, di­rec­tor of em­ployee ben­e­fits at health bro­ker­age Ben­o­va­tion, said th­ese plans are a bridge to more com­pre­hen­sive cov­er­age. “Most of the em­ploy­ers I’m speak­ing with are see­ing it as a step­ping stone,” he said.

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