Comments needed for health plan

Comments needed for health plan

August 7th, 2012 in Opinion Times

Gov. Bill Haslam's administration has been needlessly slow in initiating the planning that is necessary to establish a nonprofit state-run health insurance exchange -- the most essential element of the Affordable Care Act. But better late than never. His insurance commissioner, Julie McPeak, is still gathering public and stakeholder comments regarding the level of coverage to be provided in the model baseline health insurance plan. That plan will set minimum requirements for any plan offered in the exchange by other interested health insurers.

This is critically important work, all the more so because the ACA does not mandate a federal baseline level of coverage that states must provide. That is left up to the individual states. Unfortunately, the public comment period and the schedule of hearings to receive public comments have been insufficiently advertised and little noticed among the general public. The deadline for providing comments is this coming Friday, Aug. 10.

At McPeak's meeting last Wednesday in Cleveland, just 20 people attended. Fortunately, Dr. B.W. Ruffner, an oncologist and former president of the Tennessee Medical Association was there to urge McPeak to develop a broad plan. He recommended adequate coverage of prescription drugs and behavioral health care, along with preventive and normal care standards. Expectations for the latter include maternity, ambulatory and emergency care, a broad range of preventive and wellness care and rehabilitation.

Under the ACA, insurers that enter the exchanges must provide flat community-based rates, take all comers, and provide policies that are at least equal to the state's baseline comprehensive care policy. Insurers in the exchanges will also have to provide clear and full descriptions of their policies in a standardized form that allows consumers to compare each policies' benefits. All insurers, whether or not they enter the exchange, will be banned from using exemptions for pre-existing conditions, annual and life-time limits on coverage, and cancellation of policies when illness occurs.

It would have been better if the Obama administration had established adequate minimum standards for comprehensive insurance policies to be offered in the states' exchanges. The federal government's long experience in providing health insurance purchase options for federal employees and for Medicare, Medicaid and the military's TriCare surely would have made formulation of minimum comprehensive insurance for state exchanges relative easy.

That the ACA leaves it up to each state to set minimum insurance standards was a deferential move to acknowledge states' rights in charting individual paths on health care reform. In any case, most individuals and families who do not have access to an affordable employer-based health insurance plan will receive significant federal subsidies to enable them to purchase comprehensive insurance at an affordable rate.

Commissioner McPeak's job now is make sure the baseline state plan meets that standard when she unveils the model guidelines next month. Tennesseans can still submit recommendations through Friday by email to