Health Insurance and You!

As states set up their online health insurance exchanges and ready them for launch in 2014, many are grappling with the question of exactly which benefits plans will be required to cover. According to a blog post by Ezra Klein of the Washington Post, the health reform law listed ten broad categories that states needed to address, but left the specific definitions of each up to the Department of Health and Human Services (HHS). HHS then passed that decision on to the states and suggested different approaches to doing so.

In the last week or so, California lawmakers have made some progress on that question. One proposal, currently awaiting a decision from Gov. Jerry Brown, would benchmark the state’s essential health benefits to those offered by a certain Kaiser Permanente plan for small business employees. As Mr. Klein writes, the plan includes some expected benefits – such as annual physicals, vision and hearing tests, family planning counseling, vaccines, and screenings – and some surprises, including acupuncture for pain management. The plan includes coverage with a co-payment for prescription drugs, mental health services, and substance abuse treatment.

This was not the only health insurance issue California’s legislature discussed last week, according to an article by Kevin Yamamura of the Sacramento Bee. Another recent question was whether insurers could charge higher premiums to certain groups – in this case, smokers. State lawmakers, in Senate Bills 951 and 961 and Assembly Bills 1453 and 1461, gave state insurance regulators the authority to enforce parts of the health reform law, including the requirement that insurers cover all people regardless of their health status and preexisting conditions. As part of these bills, insurers would not be allowed to charge smokers higher rates.