Download PDF Report >>> Response to Essential Health Benefits Bulletin
SUMMARY
Health and Human Services (HHS) Bulletin sets guidelines for defining Essential Health Benefits (EHB). It ingeniously allows each State to have a say in its own EHB definition, yet provides a method to bring closure to the process should any State not reach an agreement. It also allows States to add benefits, but at their own expense. With federally providing premium assistance to lower income enrollees, it is important that only minimum State EHB premiums be supported.
The bulletin will likely require every State to add or enhance some services that are not now offered to small groups and individuals. This may lead to a premium increase for small groups and individuals not eligible for premium assistance. Until actuarial efforts identify these costs, this remains an unanswered issue. Everyone is concerned about higher costs, but Insurers have added concerns about adverse selection. The Affordable Care Act (ACA) mitigates this concern by reinsurance and risk adjustment provisions in the act. Continue reading
Filed under: Analyses, Health Costs, Health Insurers, Healthcare Reform, Medicare & Medicaid | Tagged: ACO, essential benefits | 1 Comment »
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