Under the Affordable Care Act (ACA), the Secretary of HHS is tasked with defining an Essential Health Benefit package (EHB) which will be the blueprint for all individual and small group policies written inside and outside of the Exchange -- the bottom line of what has to be covered. The ACA lists 10 categories of benefits that must be covered.
Most states have some coverage mandates -- overnight stays for mastectomies, ostomy supplies, Lyme disease treatment, etc. If a state chooses to mandate coverage above and beyond the EHB, the state has to pay the cost of these coverage mandates.
Last December, HHS issued guidance saying that the states would be able to choose their own EHB by selecting a benchmark plan from among the three largest small group plans, the largest HMO in the state, the three largest employee benefits plans, and the three largest federal employee plans (FEHBP). HHS said that, if a state chooses a plan that includes mandates as its EHB benchmark plan, the states do not have to pay for those mandates. HHS said it may -- MAY, not will -- revisit the EHB selection in 2016. But until then, if we choose a Connecticut plan, it will include the mandates, and that won't cost the state anything extra.
For reasons I do not understand, the State of Connecticut is nervous about choosing a plan that includes mandates. I see this as silly -- we don't know if HHS will revisit the EHBs; if they do so in 2016, we can revisit it at that time; but for at least two years, we get the mandates and we get them for free.
But there's another issue at stake here, and that's choice. The FEHBPs all restrict coverage of abortion to cases of rape, incest and a threat to the life of the mother. No elective abortion, which is covered under every Connecticut-based plan. So if we choose a FEHBP as the benchmark, we greatly restrict insurance coverage of abortion in Connecticut.
Connecticut has always been a very strongly pro-choice state, and you would think that this potential abridgement of the right to choose would end any discussion of the FEHBP as a benchmark plan. Still, the State is pushing the FEHBP for fear that, in 2016, they MAY have to pay for the mandates. Maybe. Four years from now.
There are some issues that matter more than the cost of paying for the mandates. One such issue is choice. Connecticut -- the Exchange Advisory Committees, the Exchange Board, the Malloy Administration, and the General Assembly -- must NOT curtail the right to choose in the course of making a choice of EHB benchmark plans.
I'll be at the Health Plan Qualifications advisory committee meeting today at 10:30 am in Room 1B of the LOB. I plan to raise this issue, and I hope others will do so, as well. Abortion rights may not be curtailed because of some speculative budgetary concern down the road. If HHS changes the EHB in 2016, we can revisit the issue of the mandates. But for now, the FEHBPs must be rejected as a viable option. A woman's right to choose hangs in the balance. Jennifer