CT Mirror reporter Deirdre Shesgreen covered AHIP’s policy conference this week where the issue of essential benefits was discussed. Here are a few highlights from her story looking at the impact of this provision in the new health care law:
- Kathleen Nolan, the top health care advisor at the National Governors’ Association, said she’s had several governors tell her that the definition of essential benefits will be the “the linchpin” in their decision on whether to do a state exchange or not.
- “If they can’t make it fit their needs and their environment and their programs, then they’re just signing up for something they’re not going to be able to sustain,” she said. “A lot of governors are very interested in running this exchange, but they have to be able to do it in their way. This is one of the most critical issues” in determining that.
- Jonathan Gruber, a health economist at Massachusetts Institute of Technology, said an overly expansive definition of essential benefits could undercut the main goal of health reform: getting more of the uninsured covered.
- He noted that although there is a mandate to buy insurance, individuals are eligible for an exemption if the cost of a plan exceeds 8 percent of their income.
- He noted that the essential benefits package will not only impact the cost of private insurance, but also of government programs.
- He said defining that state’s benefits taught him another lesson: Once government provides a benefit, it’s very hard, if not impossible, to take it away.
- “It’s hard to reverse if you overreach,” Gruber said. Another reason to start small.
