Mary Katherine Ham @ Hot Air:
Before Health and Human Services Secretary Kathleen Sebelius pushed back the deadline last week, governors were required to tell the feds by Nov. 16 whether they planned to build their own state-based exchanges for health care or let the federal government do it for them. They were required to submit detailed plans for building those state exchanges by the same day.
But it was not until yesterday that the federal government finally released a proposed regulation defining “essential health benefits”— a fundamental rule for planning these exchanges. See, ObamaCare legislation promised that come 2014, health insurance plans would have to cover certain “essential health benefits” in 10 broad categories to be compliant with the new federal law, but it passed on defining the specifics until now.
In other words, the federal government was demanding governors finish their detailed plans for implementing state-based health care exchanges four days before it even told them exactly what plans in those exchanges had to look like.
The task of defining “essential health benefits” fell to the Department of Health and Human Services, which kinda sorta kicked it to the states in a 13-page informal guidance it published in December 2011. That guidance suggested states choose a plan as their benchmark from these:
(1) the largest plan by enrollment in any of the three largest small group insurance
products in the State’s small group market
(2) any of the largest three State employee health benefit plans by enrollment
(3) any of the largest three national FEHBP plan options by enrollment or
(4) the largest insured commercial non-Medicaid Health Maintenance Organization
(HMO) operating in the State.
This allowed some flexibility for states and perhaps spared the insurance market more major disruption caused by one federally mandated standard. But not all suggested state plans include benefits in each of the 10 categories required under ObamaCare, and states didn’t know until yesterday whether and how they’d need to supplement the plans they chose. Hell, they didn’t know until yesterday, for sure, whether HHS would actually make a rule in accordance with the guideline it issued. States were to a great degree taking HHS’ intentions on faith and guessing at what their benchmark plans might be missing. Kaiser reported on some of the problems with this approach in September:
States are still waiting for more guidance from the administration on how to define habilitative services — one of the benefits covered in the law — and whether the federal government will require plans to offer more than one prescription drug in each class of drugs, said Caroline Pearson, a director at Avalere Health. Habilitative services differ from rehabilitation in that the patient is learning a new skill, such as walking for the first time, rather than having a former function restored.
Lo and behold, the new rule requires significantly more prescription drug coverage than theguidance suggested and states prepared for. To borrow and twist a phrase: Things that could have been brought to my attention before yesterday!