Exchange Board Approves ‘Essential Health Benefits’
by Christine Stuart | Sep 28, 2012 5:30am
(8) Comments | Commenting has expired
Posted to: Health Care
He used to be the president and CEO of ConnectiCare, but on Thursday he voted against the “essential health benefits” plan fashioned after a ConnectiCare HMO benefit package.
The plan adopted by the Insurance Exchange Board Thursday is expected to be the floor for the type of health care benefits the state will offer through its insurance exchange in 2014. Under the federal Affordable Care Act individuals and small businesses will be able to comparison shop for health insurance on the exchange and each state gets to determine how far those minimum levels of coverage reach.
Mickey Herbert, the lone Insurance Exchange Board member to vote against the essential health benefits package, said the plan was just too rich for many individuals and small businesses in the state.
Every state’s essential benefit package is required to provide emergency services, mental health services, hospitalization, prescription drugs, pediatric services, maternity care, and rehabilitation among other medical services. Connecticut’s plan will also include coverage of elective abortions.
Acknowledging the irony that he voted against a plan his former company created, Herbert said he had a feeling a lot of the Insurance Exchange Board members agreed with him, but that he was the only one to “fall on his sword.”
Office of Policy and Management Secretary Ben Barnes said that if the state allows for more variety in the benefits provided “we will have three sizes of drink but we will be allowing different flavors and providing more choices to consumers.”
“I don’t want to have any more disruption in the variety offered to consumers,” Barnes said.
Another member mentioned that Connecticut is a “mandate rich” state so there isn’t much wiggle room in the options for the plan.
The plan has a more than 60 percent actuarial value and Herbert said many of the plans currently offered by small businesses are at the 40 percent level.
“You’re going to have a lot of those small businesses just dropping insurance,” Hebert said.
There’s also the risk that many of them may consider self-insuring in order to get out of the exchange which means they would have to have money in the bank to cover their employees’ claims.
Not only does the essential health benefit plan the board adopted raise the floor, “but it’s like we’ve taken the elevator to like the 12th floor,” Herbert told the board.
He didn‘t get a lot of disagreement from his colleagues on the board.
“Affordability is my overriding concern and I think it is fundamental to the success of the exchange,” Barnes said.
Kevin Counihan, CEO of the Insurance Exchange, said it shouldn’t be lost on the board that the plan they’re talking about is one of the most popular plans in the state at the moment.
Anne Melissa Dowling, deputy commissioner of the Insurance Department, who worked with the advisory committee in choosing a plan said there wasn’t much difference between ConnectiCare and the other plans out there. It just happened to be a little richer, but not by much, in benefits.
Dowling suggested the board recommend that the legislature review all the state’s health care mandates during the upcoming legislative session.
Lt. Gov. Nancy Wyman said the board has no ability to ask the legislature to take on such an assignment, but it can look at the mandated coverage itself and offer its thoughts to the legislature.
Mandated benefits in Connecticut require private insurance plans to cover everything from infertility treatments to prostate and breast cancer screenings and autism therapies. Each of those mandates increases the costs of insuring people and ultimately the premiums individuals and businesses pay for coverage.
Click here for the Insurance Department’s review of some of the state’s mandates.
By adopting the essential health benefits package Thursday Connecticut’s Insurance Exchange Board is on schedule to meet the deadlines for implementation set forth by the U.S. Department of Health and Human Services. It’s one of about 13 to 15 states which are on track to meet the deadline.
Tags: insurance exchange board, essential health benefits, Mickey Herbert, Lt. Gov. Nancy Wyman, Ben Barnes, affordability
(8) Comments
posted by: JAM | September 28, 2012 9:05am
No doubt many other states setting these exchanges up will offer policies containing only the minimum Federal requirements.
It’s amazing to me how time after time our state officials ignore reality, and go out of their way to make Ct less competitive.
posted by: Noteworthy | September 28, 2012 9:13am
What’s the point of setting a floor for insurance coverage, if the floor cost is above the financial heads of those who would consume it? Are these people just going through the motions and checking the boxes off in order to meet a deadline or are they actually trying to craft something that works?
posted by: RE-Windsor, CT | September 28, 2012 3:41pm
Someone explain the logic of not offering a base policy. This is the beginning of what will be a mess.
I am reminded of an old passage that I will add the last line to:
The more prohibitions you have,
the less virtuous people will be.
The more subsidies you have,
the less self-reliant people will be.
The more health insurance you have the less healthy people will be.
posted by: GoatBoyPHD | September 28, 2012 5:38pm
CHeck the actuarial value for men versus women in the policy after the special interest groups were done pushing their ‘War on Men’ politics. Check the actuarial value versus Medicaid and State Worker policies. When you see the results: puke!
The hidden tax: blue collar males working for private industry using the Exchange get the least benefits as measured by actuarial value and out of pocket expenses.
This is the hidden tax. Ask Veltri for the figures.
Physicians for National Health have been writing about the inadequacies and built-in pricing distortions of the ACA for years and the way in which local politics enshrines policy dixcrimination among the working class while playing political favorites with the like of Lucky Luciano and the AFSCME crowd when trading health care benefits for votes and campaign money.
http://tinyurl.com/9k8w7ts
posted by: Cdave | September 28, 2012 11:29pm
The plan covers just about everything which will make it unaffordable for the people it is suppose to help.
One correction to a point in the article. The plan does not mandate coverage of abortions. The ACA forbids abortions of any type as being part of the essential health benefits plan approved by an exchange.
posted by: GoatBoyPHD | September 29, 2012 2:14pm
Abortion is covered under CT law with separate funding. This was voted on in June and covered by the News Junkie.
http://tinyurl.com/d6gfs5z
posted by: RJEastHartford | September 30, 2012 10:37am
As corporations sell off business units to unlock value for hedge fund investors, while other corporations see stable revenue and earnings with an increase in equity value on Wall Street yet each layoff highly skilled, experienced workers. Some of these jobs are then refilled at much lower compensation. Where do people turn for help in this case? Corporate political money pulls the string of the tea party. We are cutting our own throat -lower wages, no health insurance, no retirement….all costs, now no government costs either, no taxes…the 1% is holding the knife. (and probably turning a profit on it). Stay out of the minutiae and look at the big picture.
posted by: Cdave | September 30, 2012 10:18pm
GoatBoyPHD - Sorry, NewsJunkie got it wrong. If you look at the essential benefits package sent to the Exchange Board in July and voted on this week there is a very important footnote. Check page 39. The report lists pregnancy termination as part of the benchmark plan, but then excludes it in the footnote because the ACA says that it cannot be mandated coverage in the essential health benefit plan. The Board should just not have listed pregnancy termination (I.e. abortion).