Exchange Board Approves ‘Essential Health Benefits’
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.