Implementing Health Reform: Essential Health Benefits And Medical Loss Ratios

[eridani]

Implementing Health Reform: Essential Health Benefits And Medical Loss Ratios
By Timothy Jost
http://healthaffairs.org/blog/2012/02/18/implementing-health-reform-essential-health-benefits-and-medical-loss-ratios/

The FAQ do go some distance toward clarifying a number of the issues left open by the initial bulletin, in particular how plan flexibility will (and will not) work, that states will not establish a new EHB every year, and that a state?s commercial plan EHB need not apply to Medicaid. The approach selected by HHS will allow states to maintain their coverage mandates (or at least those that apply to the small group market) until 2016, but will preclude the addition of new mandates. It is still hard to imagine how this is all going to work out in practice, however, and more to the point how plan compliance will ever be monitored, given the ability of plans to substitute services within categories. One must wonder whether in the end it might not have been more straightforward simply to come up with a federal menu of services.

CMS - FAQs on essential health benefits:
http://cciio.cms.gov/resources/files/Files2/02172012/ehb-faq-508.pdf

Comment by Don McCanne of PNHP: Being the fine gentleman he is, Professor Jost politely states, "One must wonder whether in the end it might not have been more straightforward simply to come up with a federal menu of services."

You don't have to wonder. Not only should we have a national standard calling for comprehensive benefits for everyone, we also should have simplified the financing system to make it more equitable and much more efficient so that health care would be accessible and affordable for everyone.

[CAPHAVOC]

1. Improbable

Insuring the uninsurable is a losing proposition. ACA will become a Pox on the Democratic Party. We already had a national plan that worked. It was called Medicare Part A and B. Extending the plan to all citizens could have prevented the forthcoming health care disaster. Sad.

[eridani]

2. Yes, it could have

Maybe we can get single payer in before that, though.