Starting this year, all insurers must provide certain essential health benefits as required under the Affordable Care Act. However, business groups are calling for restructured benefits while consumer advocates are pushing to uphold the coverage requirements, Kaiser Health News reported.
A business interest group including the U.S. Chamber of Commerce and the National Retail Federation at a briefing Monday on Capitol Hill claimed the current rules have caused excessive premium hikes.
"What I hope is that they tear down the existing EHB and rebuild it from the bottom up," Neil Trautwein, employee benefits policy counsel for the National Retail Federation, told KHN. He called insurers "perfectly capable" of providing benefits without needing federal requirements to do so.
Meanwhile, health advocacy group Families USA will work with National Women's Law Center and the Georgetown Center for Children to preserve the current health benefit requirements. "People need to be cautious about thinking of the cost of premiums without thinking about what you're getting for the premiums," Cheryl Fish-Parcham, Families USA's private insurance program director, told KHN.
Because the reform law lets states decide how to interpret the 10 categories that make up essential benefits, implementation varies across markets. For instance, although the health benefit requirements include preventive services, insurers interpret the provision differently, leading to confusion and uncertainty about what treatments they must cover.
With such uncertainty, some health plans already have missed the mark on essential benefits. Most of the healthcare services excluded in the pre-Affordable Care Act insurance market have remained excluded in the ACA era, according to a February study from HealthPocket. And health plan drug benefits in Massachusetts and California don't meet essential health benefits requirements, even though the plans received approval, concluded March research in the American Journal of Managed Care.
- read the KHN article