SmallBiz Vote

Will “essential health benefits” raise your rates?

With the Affordable Care Act force you to get health benefits you don't want?

The National Association for the Self Employed, a group that helps entrepreneurs secure benefits including health insurance, has warned that the Affordable Care Act threatens to increase health insurance rates for the self employed by 10-13 percent by 2014. The organization predicts that a section of the bill mandating "essential health benefits" will force insurance companies to expand the minimum benefits they provide, even in high-deductible plans. Self-employed individuals therefore "may have to pay for a health insurance product that they don't need or want," says NASE spokeswoman Katie Vlietstra.

What are essential health benefits? That remains to be seen. According to the Affordable Care Act language, the Secretary of Health and Human Services will define them, "except that such benefits shall include at least the following general categories and the items and services covered within the categories: (A) Ambulatory patient services. (B) Emergency services. (C) Hospitalization. (D) Maternity and newborn care. (E) Mental health and substance use disorder services, including behavioral health treatment. (F) Prescription drugs. (G) Rehabilitative and habilitative services and devices. (H) Laboratory services. (I) Preventive and wellness services and chronic disease management. (J) Pediatric services, including oral and vision care."

Vlietstra acknowledges that essential health benefits and minimum coverage requirements are yet to be defined. But, considering those minimum items and services outlined in the bill, she asks, "What about the single, young man who has to have prenatal coverage? I think it [will be] those items that will inflate insurance costs and impact the pocket of the consumer the most."

But Emory University health policy professor Kenneth Thorpe is more concerned that essential health benefits will not be broad enough. Writing two weeks ago on the blog The Hill, Thorpe, who is a former Deputy Assistant Secretary to HHS, reported that "the Obama Administration is moving forward aggressively to determine which health benefits are essential and should be covered by insurance companies under the law."

Citing the statistic that "nearly half of Americans suffer from at least one chronic disease, and the treatment of these diseases accounts for 83 cents of every dollar spent on healthcare in the United States," Thorpe recommended HHS could actually save society money in the long run by defining as "essential" coverage for the prevention and treatment of those diseases. He urged inclusion of: "intervention-focused programs designed to prevent obesity, help people stop smoking, and avoid the lifestyle choices that lead to diabetes and other preventable chronic diseases;" as well as "the mental and substance abuse disorder services that are just as important as coverage for regular physical checkups and diagnostic care;" and "patient protections similar to those in Medicare that allow for broader drug coverage" instead of permitting insurers to sharply restrict the drugs that a physician may prescribe under their plans.

The legal fight about whether the Affordable Care Act is constitutional is over, but the battle over the law's reach has just begun.

As a small business owner or self-employed person, which side of the debate are you on? Are you one of the 50 percent who has a chronic disease and would appreciate a more expansive definition of "essential health benefits?" Or are you in the camp that fears being forced to pay for benefits you don't want or need? Let us know in the comments.

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