States select benchmark plans for essential health benefit required by Affordable Care Act
Twenty-four states and the District of Columbia have selected the health insurance plan in their state that will serve as the "essential health benefit" package sold by all insurers participating in the new health insurance marketplace and the individual and small-group markets beginning January 2014, according to a new Commonwealth Fund study. Designed to improve the adequacy of health coverage, the essential health benefit covers 10 broad service categories, including ambulatory patient care, hospitalization, maternity and newborn care, and prescription drugs. The federal government allowed each state to choose a benchmark plan to help meet the Affordable Care Act requirement that the essential health benefit reflect a typical employer health insurance plan.
The report, Implementing the Affordable Care Act: Choosing an Essential Health Benefits Benchmark Plan, by Sabrina Corlette and colleagues at Georgetown University, reviews states' progress in selecting these benchmark plans between January 1, 2012, and October 15, 2012. The authors found that 19 of the states that selected plans chose existing small-group plans—typically employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans. For states that did not select a benchmark plan, the federal government will designate the largest small-group plan in the state as the benchmark, meaning that the majority of states will have the most widely purchased small-group plan in the state as the basis of their essential health benefit. According to the report, selecting existing small-group market plans, which are similar to what many consumers already have, will likely mean a smoother transition into the new marketplaces and an easier adjustment to the new rules.
"Many consumers who purchased health plans on their own do not have insurance that covers all their health needs," said Commonwealth Fund vice president Sara Collins. "The new essential health benefit is designed to ensure people have comprehensive plans. But the federal government allowed states considerable flexibility in adopting this new standard to fit their local insurance markets."
In an in-depth investigation into how 10 states arrived at their benchmark plan, the authors found that states conducted analyses of plan enrollment and costs, and engaged consumer and patient groups, insurers, and specialty physicians in their decision-making process. The desire to preserve state benefit mandates not included in the federal essential health benefit package was also a factor in choosing benchmark plans.
"State officials are now turning to implementation of the essential health benefits requirements," said Corlette, lead author of the report. "Several officials noted that they would likely need to enact state legislation to ensure their departments of insurance will have the authority to enforce these new benefit standards for consumers."
The Department of Health and Human Services (HHS) will evaluate the benchmark selection process and may choose to revisit it in 2016. If that is the case, the authors recommend that the federal government establish minimum standards that states must use when selecting their benchmark plans. Noting that state officials have unanswered questions about implementation of the essential health benefit, the authors say that HHS should be responsive to and flexible in accommodating states' needs as the transition progresses.
"We are in the process of a significant shift in how health insurance is packaged and sold across the country, and the essential health benefit is a remarkable change," said Commonwealth Fund president David Blumenthal. "For the first time, consumers will be guaranteed comprehensive insurance coverage that will enable them to get the health care they need."
The report will be available on March 13 at: commonwealthfund.org/Publications/Issue-Briefs/2013/Essential-Health-Benefits-Benchmark.apsx.
Methodology: This analysis is based on a review by researchers at the Georgetown University Health Policy Institute's Center on Health Insurance Reforms of new action in the 50 states and the District of Columbia between January 1, 2012, and October 15, 2012 to select an essential health benefits benchmark plan. The review of new action includes an analysis of state laws, regulations, subregulatory guidance, state websites, press releases, and other publicly available information related to benchmark plan selection. The resulting assessments of state action were confirmed by state regulators.
The researchers also conducted in-depth interviews with state officials and analyzed non-legal sources of information that include analyses, reports, and meeting minutes or transcripts in 10 states. These 10 states—Arkansas, Arizona, California, Connecticut, Mississippi, Montana, North Carolina, North Dakota, Utah, and Washington—were chosen because of their diverse approaches to selecting a benchmark plan. These approaches largely reflect the diversity of approaches in all 50 states and the District of Columbia.
This analysis is limited to state processes and decisions that took place during the study period of January 1, 2012 to October 15, 2012.
Provided by Commonwealth Fund
- New report: State action on Affordable Care Act's 2014 health insurance market reforms Feb 01, 2013 | not rated yet | 0
- Mental health and substance use disorder benefits expanded Feb 22, 2013 | not rated yet | 0
- Half of Americans with individual health plans could gain better coverage under the ACA: report May 23, 2012 | not rated yet | 0
- Study: Drug coverage to vary under health law Dec 04, 2012 | not rated yet | 0
- Nearly all states have taken action on Affordable Care Act's Patients' Bill of Rights Mar 22, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
Bed sharing with parents is linked to a fivefold increased risk of sudden infant death syndrome (SIDS), even when the parents are non-smokers and the mother has not been drinking alcohol and does not use illegal drugs, according ...
Health 1 hour ago | 1 / 5 (1) | 0
Doctors tell people with a heart-zapping device in their chests to give up intense sports like basketball and soccer in favor of golf or bowling. But lots of patients ignore that advice—and now new research is challenging ...
Health 2 hours ago | not rated yet | 0
Little is known about the effect of physical education (PE) on child weight, but a new study from Cornell University finds that increasing the amount of time that elementary schoolchildren spent in gym class reduces the probability ...
Health 4 hours ago | not rated yet | 0
Living near a major roadway during the prenatal period is associated with an increased risk of respiratory infection developing in children by the age of 3, according to a new study from researchers in Boston.
Health 6 hours ago | not rated yet | 0
People who are consistently exposed to both wood smoke and tobacco smoke are at a greater risk for developing chronic obstructive pulmonary disease (COPD) and for experiencing more frequent and severe symptoms of the disease, ...
Health 6 hours ago | not rated yet | 0
New research suggests that a compound abundant in the Mediterranean diet takes away cancer cells' "superpower" to escape death. By altering a very specific step in gene regulation, this compound essentially re-educates cancer ...
4 hours ago | 4.7 / 5 (7) | 1 |
(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.
1 hour ago | 4.3 / 5 (6) | 1 |
Turns out, that old "practice makes perfect" adage may be overblown. New research led by Michigan State University's Zach Hambrick finds that a copious amount of practice is not enough to explain why people ...
2 hours ago | 3.6 / 5 (5) | 0 |
Older prostate cancer patients with other underlying health conditions should think twice before committing to surgery or radiation therapy for their cancer, according to a multicenter study led by researchers in the UCLA ...
2 hours ago | not rated yet | 0 |
A new diagnostic test for a worm infection that can lead to severe enlargement and deformities of the legs and genitals is far more sensitive than the currently used test, according to results of a field ...
2 hours ago | not rated yet | 0 |
Researchers have pinpointed a catalytic trigger for the onset of Alzheimer's disease – when the fundamental structure of a protein molecule changes to cause a chain reaction that leads to the death of neurons ...
5 hours ago | 5 / 5 (2) | 0 |