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Patient advocacy groups ramp up public campaign for coverage mandate
Patient advocacy groups across the country are ramping up their requests to have their priorities included in mandatory coverage guidelines under the federal healthcare law.
The public campaign is expected to heat up over the next several months as federal regulators get closer to deciding the level of coverage private health plans will have to provide if they want access to federally subsidized insurance exchanges in 2014. The Institute of Medicine issued recommendations late last week that spell out a methodology rather than specific requirements for the law's "Essential Health Benefits," setting up a showdown between patient advocates concerned with quality of coverage and business groups that are worried about spiraling healthcare costs.
In an action alert, the Campaign to End Obesity Action Fund reminds supporters that the group "has actively sought to have comprehensive obesity treatment services included in such a package and has expressed disappointment at the lack of clarity in the [IOM] report. Now, the Action Fund will turn its attention to [the Department of Health and Human Services], which will seek public input in drafting the essential health benefit package."
And the National Health Council, which represents people with chronic diseases and disabilities, said HHS "needs to go a step further to address the needs of patients and adopt the specific regulatory language proposed by patient organizations."
This includes "patient protections that address discriminatory utilization practices, unfair cost sharing practices, and continuity of care;" navigation and care coordination services; and development of an exceptions and appeals process.
Others counter that the IOM's decision to focus on costs and peg the benefits to the cost of a typical small employer plan is the right approach.
A new coalition regrouping business groups like the U.S. Chamber of Commerce, the insurance industry and pharmacy benefit managers said affordability and flexibility should be "paramount" concerns for HHS.
"HHS has an opportunity to develop an essential health benefits package that is both affordable and flexible to ensure workers can get the health coverage they need," Brendan Daly, executive director of the Essential Health Benefits Coalition, said in a statement. "We look forward to working with HHS Secretary Sebelius toward that crucial goal."
Republicans, meanwhile, quickly jumped on the IOM's recommendations to slam the law.
"The Institute of Medicine couldn't be more clear that the benefit mandates in the health law can only lead to higher costs for families and small businesses," Orrin Hatch (Utah), ranking member of the Senate Finance Committee's Subcommittee on Health Care, said in a statement. "I urge Secretary Sebelius to examine these recommendations with care and to understand that these mandates are a lead weight around the necks of families and businesses at a time of economic uncertainty and high unemployment."
Others warned that even if federal regulators opt for a conservative approach, states will be under pressure to add "diseases du jour" to their exchanges.
"The states are not likely to give up their state mandates lightly," said Maureen Martin, senior fellow at The Heartland Institute. "So the open legal question is whether all the varying state requirements still remain in place or whether they are pre-empted by the federal law. Still another reason why health insurance premiums will rise until this issue is resolved."
Patient advocates aren't deaf to cost concerns, and are waging their campaigns accordingly.
"Obesity prevention and treatment play a vital role in scaling back the unsustainable health care costs attributed to this epidemic," the Campaign to End Obesity Action Fund said in its statement. "[The fund] looks forward to working with HHS in an effort to advance an essential health benefits package that will help curb one of America’s costliest diseases."
