Some advocacy groups, such as the National Health Council and Families USA, praised the rules for broadening coverage to patients and for ensuring that health insurance companies will not deny coverage to people because of factors such as age and health problems. In the market-reforms regulation, HHS outlined factors that insurers in the individual and small-group markets could use to vary premiums.
It also noted that health insurance issuers would be required to maintain a single, statewide risk pool for each of their individual and small-employer markets, unless a state opts to fuse the individual and small-group pools into one. As a result of that provision, premiums and annual rate changes would be based on the health risk of the entire pool.
But it's the essential health benefits proposed regulation that has and will continue to consume the most attention as the healthcare industry attempts to understand and respond to the draft rules in the coming weeks. That's especially true for insurers working to design their benefit packages while playing a game of beat the clock before they market those plans next October.
HHS said it received more than 11,000 comments on the two bulletins it released in the past year, including one on essential health benefits in December 2011 and one last February on the actuarial value component—which is calculated as the percentage of total average costs for benefits a plan will cover.
Hours after the regulations were released, the Children's Hospital Association criticized the take on essential health benefits for lacking a clear definition of pediatric services and said HHS should—at a minimum—add states' Children's Health Insurance Program plans as a benchmark option for children's coverage in a pending final rule. And America's Health Insurance Plans President and CEO Karen Ignagni said in a statement that the essential health benefits rules will coincide with the new restrictions in the law's age-rating rules that will also take effect in January 2014. Both provisions, Ignagni said, could provide incentives for young, healthy people to wait to buy insurance until they are sick or injured, which will increase costs for everyone else.
The argument that coverage will be more expensive for younger Americans is premised on HHS' approach to insulating older enrollees from large rate increases. The proposed rule would limit the increases to one-year “age bands.”
Although the proposed rule on essential health benefits is similar to guidance HHS released in its December bulletin, one major difference is the rule's prescription drug coverage provision.