As the Department of Health and Human Services works toward setting the specifics of an essential health benefits package — the minimum coverage that would be offered by plans participating in the exchanges — stakeholders are offering actuarial models and suggestions of what they think would be the best approach.
CQ HealthBeat: All Eyes Turn To Essential Health Benefits Package As The Next Big Thing
An actuarial analysis of a model insurance policy under the health care law found that even people who qualify for subsidies may have a tough time affording insurance if they have a chronic condition. The analysis released Wednesday by Avalere Health and the National Health Council, which advocates for chronically sick people, estimated what premiums and out-of-pocket charges would be for a model plan similar to one offered to federal employees by Blue Cross Blue Shield. They assumed that such a plan's benefits would come close to whatever federal officials set as the health benefits package under the law (Norman, 8/3).
Politico Pro: Coalition Supports Broad Benefits Plan
A coalition of groups that represent patients with costly health conditions wants HHS to develop a benefits package that would establish a baseline of services, but then give flexibility for health plans to accommodate individual needs — especially for patients with chronic diseases or disabilities. The National Health Council released its report, "A United Patient Voice on Essential Health Benefits," Wednesday to outline its findings and recommendations on the essential health benefits package — the minimum coverage for health plans in the exchanges — and to encourage CCIIO to include comprehensive patient regulations in the benefits package (Mann, 8/3).
Meanwhile, news outlets report on developments related to health exchanges and co-ops —
Politico Pro: States Unlikely To Go For Regional Exchanges
HHS is providing a pathway for states to build multistate exchanges, but the dominating message from local health reform leaders is that they're not interested in teaming up — for now, anyway. Ultimately, regional exchanges could allow states to share IT burdens while expanding the power of their purchasing pools. Still, the regional exchanges face significant policy challenges, such as who has governance responsibility and how differing insurance markets could be aligned. Further complicating things is the fact that states are struggling to build their own exchanges. Just 13 states have passed legislation enabling exchanges, while other efforts face legislative hurdles and ardent GOP opposition at the state level (Millman, 8/4).
California Healthline: Remember the Co-Ops? Overlooked Plan Raises Questions
Progressives didn't want them. Conservatives called it a Trojan horse proposal. Policy wonks scoffed that they'd never be workable. But two years after Sen. Kent Conrad (D-N.D.) floated "health cooperatives" as a replacement for the public option — roiling the nation's health reform debate in the process — CMS in July finally unveiled its $3.8 billion CO-OP program. ... For a plan that critics warned would lead to a takeover of health care, co-ops may actually need to be nurtured along. Other reform-inspired initiatives to help consumers have underwhelmed (Diamond, 8/3).
Related, earlier KHN story: HHS Sets Rules For Consumer-Controlled Health Plans (Weaver, 7/18).