The state of Ohio, among several others, has given many reasons for hedging on creating a health insurance exchange under the Affordable Care Act. One often-heard complaint is that the federal government has been so slow in conveying essential details about rules and regulations that it is practically impossible to determine how the whole program would work, let alone figure out with any certainty what it might cost to run and how to pay for it over the long term.
The Department of Health and Human Services took much of the wind out of the complaints last week, releasing proposed rules that would govern crucial aspects of the online health insurance marketplace. A 90-day period for public comment gives state health officials, consumers and the health industry enough opportunity for their input before the rules are finalized. This also should ease another complaint: that Washington is pushing through extensive changes — a “takeover” of health care, no less — without regard to the needs and concerns of different states.
The proposed rules clarify minimum requirements that would apply to all health insurers offering products for individual and small-group buyers on the exchanges. In essence, the rules aim to create a national standard, a process for meeting insurer obligations and basic coverage elements that is open and fair to consumers and insurers.
For instance, in addition to pre-existing conditions, insurance companies cannot raise premiums based on such things as the nature of a person’s work, gender or health claims. The only relevant factors that would affect premium rates beginning in 2014 would be age, family size, tobacco use and geographic differences.
As the deadlines for implementing the Affordable Care Act approach, another key concern has been the services that would be part of the basic package to be covered as “essential health benefits.” Included in the 10 categories of essential benefits, intended to be both comprehensive and affordable, are services covering medical, rehabilitative and behavioral care, prescription drugs, wellness and preventive services, lab and emergency care, maternity, newborn and pediatric care, outpatient services and hospital care. It is important to note that the benefits package would be specific to the needs in each state and pegged to a benchmark plan selected by the state.
The Kasich team has faulted the feds for a lack of details and a “one size fits all” approach. It has indicated it is leaving its options open (until a February deadline) to decide whether to join with Washington in operating an exchange. There is less reason now for delaying a decision.