The latest news out of Washington D.C. on the Affordable Care Act, (“ACA”) came this last December 2011. The administration released a proposal that allows the states to pick from several “federally” approved health insurance options. These appear to be a cross-secton of packages offered to government employees along with a HMO option.

Not surprising, some could label this “big brother” health care. Some act as if we do not know what the reform will look like and we need to wait and see. I suggest you need to roll up your sleeves and you can see what they have in mind with just a little research.

1. We know they used the Massachusetts reform plan as a model.  You should look here for clues

2. We know they want to treat us all like employees of the federal government, so look at their plan and add a few buraucratic agencies, some tax forms, applications, confusing descriptions and you have it all.

You must know by now that all states must make their health care exchange operational by 2013 and starting in 2014, it is expected that millions of Americans will be able to purchase individual coverage in the new state exchanges, with massive federal subsidies to help pay the premiums. The issue now is figuring out what the package will look like compared to the currently available coverage provided mostly by employer plans and what is available in most state individual markets. 

Determining the Right Strategy

Many benefit managers and consumer groups are trying to figure out the right course of actions. They are waiting for the final federal benchmark plan package to be released so they can understand the new national standard. However, final regulations are still not out and are not expected for several months.

The intent of the act (ACA) was to provide ACCESS to insurance and AFFORDABILITY of insurance.

So, How might that look?

If you look at the Massachusetts model you will see a cross-section of comprehensive packages. The ACA calls them essential health benefits (“EHBs”). We in Massachusetts call them minimum essential coverage or (“MEC”). One big issue for even Massachusetts is aligning our MECs with the federal EHBs. Can you imagine the work you will have aligning your corporate plan with both state and federal rules? Here is a link to the most recent Mass Health Retreat Presentation

Based on what you read, the standards will likely include plans similar to those available in your state for small groups, similar to the state employee plan, similar to the federal employee plan and as least one HMO plan in your state market area.

The proposed policy by the Health and Human Services Department suggests all plans need to address certain categories of coverage:

• Preventive care
• Emergency care
• Maternity care
• Doctor and Hospital services, prescription drugs to name the key categories.

If a state fails to offer a plan that does not cover the required categories, the state can review other plans including the Federal Employee Health Plan.

This is why I know you can learn what is coming. The standard is quite clear, therefore you need to start implementing change today before all the options available today are gone.

Consider Registering for our free webinar to learn more.