HHS urged to keep essential benefits affordable for small business

A coalition of business groups, health plans and healthcare providers is urging HHS to follow private-sector approaches as the department develops a final rule on the essential health benefits that individual and small-group plans must cover as part of the 2010 healthcare reform law.

The Essential Health Benefits Coalition, whose membership includes the National Retail Federation, the U.S. Chamber of Commerce, America's Health Insurance Plans, the American Osteopathic Association and the Pharmacy Care Management Association, submitted a list last month of six recommendations to HHS in response to the department's November proposed rule on essential health benefits.

At a news conference Wednesday in Washington, Neil Trautwein, the coalition's chairman, stressed affordability and said a major concern for the group is that the final essential health benefits rule does not put the cost of coverage beyond the reach of the nation's small businesses.

“We think the administration in its final rule should focus on allowing more private-sector strategies to achieve greater benefit value and affordability and again avoid including benefits that are not commonly offered today,” said Trautwein, who serves as vice president and employee benefits policy counsel at the National Retail Federation. “If they're not commonly offered today, there's a reason and a rationale why they're not offered.”

An underlying concern, Trautwein said, is the inclusion of state-mandated benefits in essential health benefit benchmark plans. In its December letter to HHS, the EHB Coalition asserted that state mandates often lack strong medical evidence and increase the cost of healthcare coverage. The proposed rule would permit state-mandated benefits enacted as of Dec. 31, 2011, in the essential health benefits benchmark plan for 2014 and 2015. The letter referred to that policy as “misguided,” which is why the group recommends HHS revisit it for the 2016 benefit year. At that time, the group suggests, only mandates that states can show have a strong evidence base should be included.

Dr. Geraldine O'Shea, vice chair of the bureau on federal health programs at the American Osteopathic Association, said evidence-based guidelines can address the affordability issue, and urged HHS to include these guidelines in the EHB final rule.

“When you follow those guidelines, that's where you can get really appropriate medicine,” O'Shea said in the news conference at the National Press Club. “And it should be affordable medicine because they go through a screening of many different, I'll say, academies or physician groups, that have looked at what's the best benefit—lowest risk, best benefit.”

Trautwein said he expects HHS to release the final EHB rule in the first quarter.