4-19-12 Affordable Care Act Update
In the States
As we previously noted in this space, the Department of Health and Human Services (HHS) has tasked each state with defining an essential health benefits (EHB) package that will cover 10 broad categories defined in a December 16, 2011 HHS bulletin. In combination with this task, states must also choose a "benchmark plan" from among 10 existing plans already offered in a state's private insurance market. If a state fails to select a plan by September 30, the EHB benchmark defaults to the largest small-group plan in the state.
ACS CAN and several other consumer groups have created a survey tool to identify what benefits are actually covered in some of the potential state benchmark plans. ACS CAN is particularly interested in flagging any "inside limits" that may exist within these plans -- for example, restrictions on the number of times a patient can use a particular service, such as laboratory tests or doctor visits each year. Such limits are harmful to patients with serious medical conditions such as cancer. The survey tool will hopefully help identify where limits exist in potential benchmark plans and allow ACS CAN to more effectively advocate for changes in limits that are harmful.
The survey was developed jointly by ACS CAN, the American Diabetes Association, the American Heart Association, and the Multiple Sclerosis Society and reflects 31 benefits important to a patient with one or more serious diseases. The survey is not intended to be an exhaustive list, but rather a sampling of the most commonly used services across the 10 EHB categories HHS mandates. Also, we are not asking for any cost-sharing information such as co-insurance, co-pays and deductibles as those issues will be addressed through separate HHS regulations.
The survey was created using general benefit terminology so the list may be more easily compared against insurance plan coverage documents for each state's three largest small group plans. The American Cancer Society and ACS CAN state government relations directors are coordinating this project with the three partner organizations and will be asking each state's insurance commissioner to complete the survey. Successful completion of these surveys could provide significant insight and direction on what we need to be advocating for as EHB's are defined and benchmark plans are selected.
Survey Shows Key Groups Still Unaware of Law's Provisions
A new Commonwealth Fund report on gaps in health insurance shows that segments of target audiences for two popular provisions of the Affordable Care Act are unaware of its benefits. Overall the majority of Americans know about the provision allowing individuals under 26 to stay on their parents' health insurance, but the survey also found that 40 percent of respondents ages 19 to 29 did not know about this benefit. Additionally, when questioned about the new high-risk pools, called the Pre-existing Condition Insurance Plan (PCIP), 65 percent of those without insurance and 45 percent of people in fair or poor health were unaware of that coverage option. This survey data underscores the importance of communicating more and consistently about the law's provisions that benefit cancer patients.
As always, thank you for all you do every day to support laws and policies that help cancer patients and their families
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.