Health Care Advocates Express Support for Essential Benefits Bills
Health advocates have expressed support for state legislation that would determine essential health benefits under the federal health reform law, the San Jose Mercury News reports.
However, someÂ stakeholders say that certain critical services would not be required under the bills.
The Mercury News article was produced by the California HealthCare Foundation's Center for Health Reporting. The center is supported by a grant from CHCF, which publishes California Healthline.
The federal health reform law requires states to launch online insurance marketplaces by 2014.
The California Health Benefit Exchange primarily will serve individuals and small businesses.
An estimated 4.4 million Californians are expected to use the exchange by the end of 2016 (California Healthline, 8/30).
Choosing Essential Benefits
The reform law allows states to choose the services that health insurers participating in exchanges must cover from 10 broad categories, such as "ambulatory care" and "prevention" (Kliff, Washington Post, 9/1).
Unsubsidized plans that are sold outside of the exchange also must offer the essential benefits.
The legislation would establish the Kaiser Small Group HMO 30 plan as a benchmark plan for determining essential benefits.
According to the bills, insurers would be required to cover several services, including:
- Tobacco cessation; and
- Vision screening.
Uncovered Health Services
Cary Sanders -- director of policy analysis for the California Pan-Ethnic Health Network -- said, "We're really excited to see the addition of mental health and substance abuse treatment" to the list of essential benefits.
However, she said that while vision and dental benefits for children would be covered under the bills, federal guidelines do not require coverage of those services for adults. Sanders said, "We didn't get everything we wanted."
Monning said California is waiting to hear from the federal government on whether chiropractic care should be considered an essential benefit. He noted that California could cover additional benefits beyond those required by the federal government if the state is willing to pay for them.However, he said, "With our own budget challenges in California, the prospect of getting basically a two-thirds vote to generate the resources from our general fund to cover a mandate not covered by the essential health benefits would be a heavy lift" (San Jose Mercury News, 9/1). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.