HIX Essential Health Benefits (EHB) Should Have a National Standard

by Patrick Riley 14 Aug 2013
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The Department of Health and Human Services (HHS) decided that rather than establish a national standard for EHBs they would defer to the states to choose a set of plans to serve as a benchmark for each state. Whatever benefits or attributes this one plan offers in the 10 designated categories, the remaining plans must match as their essential elements.

This policy has drawn criticism and praise from different sides in the debate. Providers and consumer groups are opposed to this way of thinking and prefer a national standard of care, which is what doctors and hospitals are accustomed to doing. But, state administrators and businesses applaud this flexibility which allows them to customize EHBs to match local resources and healthcare models.

There is no national policy for health insurance benefits. Never has been. Each state is left to police their own practices and states also mandate what certain benefits will be covered, but from state to state there is much difference. Coverage for core services - such as inpatient care, outpatient services, and primary care is typically not mandated, but most plans cover them.

Insurers and employers both have made known their grievances and positions in regard to the essential health benefits package, standardization or current policy of benchmarking plans by the states. But, there should be some level of common ground across state borders that guarantees a level of benefits agreed upon by HHS and Congress. Without a standard, too much room is left for individual interpretation and policy makers love a way to modify, codify, and relieve responsiblity. And the recipients of this political maneuvering is most always the segment of our population without a voice, the poor.

If you would like to continue this discussion please follow me on Twitter @Patrick_FrostHC

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