States need more data to define essential benefits

After revisiting requirements for health plans' essential benefits this year, states made few changes, but that may largely be due to regulators not having enough data to evaluate consumers' experiences, according to a post on the Commonwealth Fund Blog.

The ACA's essential benefits concept has proved controversial since its inception, as consumer advocates have generally supported it and business groups have opposed it, FieceHealthPayer has reported.

In their post, Justin Giovannelli, JoAnn Volk, Kevin Lucia, Ashley Williams and Kayla Connor--healthcare policy experts from Georgetown University--explain that in both 2012 and 2015, states were able to choose a benchmark plan out of 10 options; about half chose to do so, while the rest went with the government's default choice.

Among all these states, 45 plus the District of Columbia ended up going with a small-group market plan for 2014-2016, either by choice or default. That number hardly changed when they revisited their options for 2017 and beyond, as 46 states plus D.C. ended up with such a plan.

Within those plans, though, there is wide variation in the benefit packages states require, making it difficult for insurers to sell coverage across state lines, a previous Robert Wood Johnson Foundation report found.

Part of what may have led states to stay the course with the benchmark plans is that even when they revisited their choices this year, regulators only had data from the 2014 coverage year to draw upon, the authors write. That, they say, makes it difficult to know whether the benchmark approach benefits consumers.

To make better benefit-requirement decisions, states need more data from insurers--such as claims denial rates that could show service usage patterns, the authors say.

To learn more:
- read the post

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