Assuming federal health reform survives Supreme Court scrutiny, the country will, for the first time, have a standard definition for "essential benefits" that insurance plans must cover.
But deciding what to include or exclude is tricky business.
The Utah Legislative Health Reform Task Force solicited public input on this very question Tuesday at a hearing broadcast at 10 locations statewide. Insurance companies, providers and disease groups were amply represented; otherwise attendance was sparse.
Those who came, however, had strong opinions about what they want covered: everything from acupuncture and birth control to specialized therapy for autism and newborn screening for birth defects.
They told emotional tales of families bankrupted by soaring medical costs due to gaps in coverage and swelling co-pays and deductibles.
But the final analysis will likely rest on hard numbers as lawmakers seek to strike a balance between comprehensive coverage that's also affordable.
"That, and still letting people have choice, is our challenge," said task force chairman Rep. Jim Dunnigan, R-Taylorsville.
Defining an "essential benefits" package, or bare minimum of health benefits for all policies sold on Utah's online health exchange, is a requirement of federal health reform.
States have some freedom in designing their essential benefits. But they must benchmark them against top-selling plans on the market, including federal, public and small business plans.
And at minimum, they must cover: emergency services; hospitalization; maternity; newborn and pediatric care, including oral and dental services; mental health and substance abuse treatment; prescription drugs; rehabilitative services; medical devices; labs; prevention and wellness; and chronic disease management.
Providers spoke in favor of the idea, asking the state to proceed regardless of how the high court rules.
"One of the biggest problems I have is discerning which insurers will pay for what," said Ray Ward, a family practitioner in Bountiful. "I have to hire a full-time billing person for each payer, which leads to a big increase in costs."
Those in the mental health and substance abuse fields may have the most to gain from the exercise, though current benchmark plans won't meet patients' need, said Salt Lake County Substance Abuse Director Pat Fleming.
Leading plans on the market today cover 30-day hospital stays plus up to 20 days outpatient therapy, "acute doses of treatment for a chronic, relapsing disease," said Fleming, who advocates for coverage for outpatient care, which he claims costs less.
"We have a chance in Utah to be leaders on this."
Speak your mind
I Consumers can submit written comments through July 3 by emailing: LRammell@Le.Utah.gov. Lawmakers will pick a plan design on July 10 for recommendation to the Utah insurance commissioner.