The Circus Comes To Town

The Affordable Care Act requires the Secretary of Health and Human Services to define a package of "essential health benefits" which a qualified health plan participating in a state health insurance exchange must offer. FEHB plans and other group health plans operating outside the exchanges do not have to offer essential health benefits, but to the extent that they do those benefits cannot be subject to annual or lifetime dollar limits according to the new law.

The process of defining the essential health benefits package is bound to be a three ring political circus, and the circus opens tomorrow. The National Academies' Institute of Medicine has announced that "The Committee on the Determination of Essential Health Benefits will hold its first meeting on January 12-14, 2010 at the National Academy of Sciences Keck Building. The first day, January 12, will be closed to the public to observe committee proceedings. On January 13-14, there will be some open sessions." The meetings will be held in Washington, DC. The IOM has posted the wide ranging agenda for the open meetings. The first session alone should be fascinating

9:00 a.m.		Understanding Legislative Intent of Section 1302
		David Schwartz, J.D., Health Counsel, Senate Finance Committee Democratic Staff
		David Bowen, Ph.D., Deputy Director for Global Health Policy and Advocacy
		at the Gates Foundation; former Director of Health Policy; Senate HELP Committee
		Mark Hayes, J.D., Pharm.D., Greenberg Traurig; former Health Policy Director and
		Chief Health Counsel, Senate Committee for Senator Grassley

Kaiser Health News has a lengthy report that gives you a good perspective on all of the conflicting presentations to be presented at the meeting. Here's an excerpt:

HHS should not get into "the details of each category of care," America's Health Insurance Plans says in a letter to the IOM panel.  Essential benefits are those "proven effective based on science" and they should be updated regularly. Additionally, the trade group says HHS should consider allowing restrictions on the number of visits covered in certain situations to keep premiums affordable.

"The broader the benefit package, the higher the cost for families and employers," says Robert Zirkelbach, spokesman for AHIP.

Don't set limits on the number of visits, says Stephen Finan, director of policy for the American Cancer Society Cancer Action Network.   "If a patient requires chemotherapy every week for a year… they should not be hindered by an arbitrary rule about only getting 35 visits."

"If it's medically necessary, it should be covered," Marina Weiss, a senior vice president at the March of Dimes, says

California Healthline reports that

According to CQ HealthBeat, it is unclear if officials will seek a specific list of treatments or ask insurers to mirror benefits in particular plans, such as the Federal Employee Health Benefits Program. The rules might enable insurers to design plans differently, as long as they provide a certain value of coverage overall.

IOM will publish recommendations for HHS by September, and HHS will issue its proposed rules by the end of the year, giving insurance companies time to adjust plans before the provisions take effect.

The FEHBlog will be tracking this important rule making process.