The road to full implementation of the Affordable Care Act in 2014 is a journey of countless tiny steps. A state health care task force took one of those steps last week when it recommended an essential health benefits package. That package will set a floor for health insurance coverage in the individual and small-group markets that will be served by the state exchange.
The Legislative Health Reform Task Force recommended the PEHP Basic Plus policy, a high-deductible policy offered by the Public Employee Health Plan. We suspect that many workers who receive their health insurance through their employers would recognize the plan as something familiar, because high-deductible plans that utilize health spending accounts are a growing part of the market.
The plan covers 10 basic areas, as the ACA requires, but there certainly are items that are not covered that would be important to many people with chronic diseases or other conditions. But that's why this plan was an appropriate choice. It sets the floor, not the ceiling, for benefits packages, mostly so that consumers who will buy their insurance on the exchange for individuals and small groups will have a basis for price comparison.
There probably is a sweet spot, an ideal, that would balance cost and comprehensiveness. Finding that sweet spot will be difficult, however, because the needs of different consumers and their ability to pay vary enormously. One reason to stick with a basic minimum plan, however, is so that it will be affordable enough to attract the so-called young immortals who do not buy health insurance now but will be required to do that under the ACA.
People may look at this policy, with its deductibles of $3,000 per person and $6,000 per family, and conclude that many young people and others of middling means would not be able to pay those kinds of deductibles. But pricing was not one of the criteria in selecting the essential benefits package. That will be determined later. This was about defining a floor for essential benefits.
Still, advocates argued that this package was not inclusive enough. Eight outpatient visits for a person suffering mental illness or substance abuse, as this package provides, might not be enough. Besides, coverage should be determined by outcomes rather than numbers of visits. That's true. Our hope is that other elements of the reform will address those issues.
The federal government still is defining rules for the essential benefit package, and there probably will be tweaks along the way. The good news is that the journey is under way.