The Politics of Autism includes an extensive discussion of insurance issues, including the impact of the Affordable Care Act.
Let’s just say that if we were waiting for the other shoe to drop, it may just have done so. A humongous, 365-page rule proposed late last week by the Centers for Medicare and Medicaid Services is the agency’s biggest attempt to put a conservative stamp on the Affordable Care Act by rewriting its rules in a way that gives insurers and states as much leeway as possible from the law’s mandates.
The proposed rule, which suggests an array of changes to how the individual and small-business marketplaces are run, most notably gives states wide latitude in carrying out the ACA’s “essential health benefits” — 10 categories of care that individual market insurers must cover to ensure consumers can access a full range of benefits.
Here’s how EHBs work: States must select a “benchmark” plan to set the standard for how generously insurers must cover essential benefits, which include categories such as maternity care and mental-health services. The benchmark plan is typically chosen from among employer-sponsored plans in order to ensure individual plans are comparably generous.
Marketplace insurers must provide the same value of services within each of the 10 categories as the benchmark plan. So if the benchmark plans covers treatment for autism or speech-language therapy, for example, insurers must cover that too, or substitute a service with equivalent value. You get the idea.
If CMS goes ahead with its proposed changes, states won’t have to choose from a limited, fixed menu of benchmark plans. Instead, they can select a la carte. For example, Ohio could choose the maternity care standards from one benchmark plan and the mental-health services from another. Wisconsin could choose the benchmark plan from North Dakota or New Jersey or Virginia.