Econintersect: The PPACA (2010 Patient Protection and Affordable Cara Act – aka Obamacare) has a requirement that states define what they think are the “essential health benefits” that need be covered in health care plans within their own state. The deadline for completing this definition was Sunday 30 September 2012. While some states have completed the required benchmark definitions, many more have not. If fact some have not even started the process. Under PPACA, the Dept. of Health and Human Services (HHS) is charged with making the definition for non-compliant states.
It appears that the states moving forward and the states that “can’t figure it out” are determined by the political parties in control. Many states that have governors who oppose PPACA are the ones who say there is insufficient information provided to make the decisions needed. States that have governments supportive of PPACA do not seem to have such a problem.
The September 30 deadline was preliminary to a final decision due by November 16 on whether the state will form their own distinct marketplaces or collaborate with the federal government to operate an exchange. The exchanges will be health insurance marketplaces where individuals can purchase health insurance with income qualified government subsidies to pay premiums. For those states that do not form their own exchange, there will be a national exchange that will be available to their citizens.
According to a report published by Price Waterhouse Coopers (Health Research Institute), only 13 states plus the District of Columbia have issued formal letters of intent to establish their own exchanges. But some of these have indicated that they do think they can be ready to implement enrollment by the PPACA specified start date of October 2013. The same report also says that 8 states have declared they will use the federal exchange, 3 more have elected a state/federal partnership. The remaining 26 states appear to be in limbo, unable to understand or define what parameters might be best for them.
Some of the states that are having problems moving forward are discussed in an article by Allison Bell in Life Health Pro, 02 october 2012:
Officials in Alabama, Pennsylvania and West Virginia have declined to select an EHB benchmark, arguing that HHS officials have failed to answer their questions about the EHB program.
In Alabama, for example, Gov. Robert Bentley, R, wrote to Kathleen Sebelius, the HHS commissioner, that he is a “staunch opponent of the Affordable Care Act.”
Bentley, a physician, said he also believes HHS has asked states to select benchmark plans without providing clear guidance.
PPACA should work to control costs by encouraging use of health savings accounts, Bentley said.
Today, “the parameters placed on the selection of the essential health benefits benchmark plan do not allow states to select innovative mechanisms, such as health savings accounts, or a variation thereof,” Bentley said. “As such, I decline to make a decision on the essential health benefits benchmark plan There is simply not enough valid information available now to make an informed choice for such an important decision.”
The following graphic defines characteristics of the additonal 39 million estimated to be insured by 2021 estimated.
Click on graphic for larger image.
- Health Insurance Exchanges: Long on options, short on time (Health Research Institute, Price Waterhouse Coopers, October 2012)
- More states post essential benefits letters (Allison Bell, Life Health Pro, 02 October 2012)