Will Wisconsin consumers be shut out of selecting new health benefit plan?

A significant decision determining the standard of health care in Wisconsin is looming, and nobody seems to be talking about it, leaving health care consumers virtually in the dark.

First, some background: Under health reform, Essential Health Benefits (EHB) consist of ten categories of services required on all individual and small group plans which include services from pregnancy and newborn care to mental health and substance abuse services to preventive and wellness care. Starting in 2014, these services must be covered with no co-pay to the consumer. Each state uses a “benchmark” health plan to serve as the EHB standard which all other health plans must meet.

EHB is important because it serves as the base benefits for all consumers.  If states determine not all their needs are met, legislators can choose to go above and beyond these minimum requirements by adding additional services to their benchmark package.

June 1, 2015 is the deadline for states to choose their new EHB benchmark plan for 2017, and judging by the non-existent media coverage of this important decision, the public will have no opportunity to weigh in on this process.

That's why this is so important:

On May 27, State Representative LaTonya Johnson (D-Milwaukee) filed an official request with Walker’s Office of the Commissioner of Insurance (OCI) requesting they delay the selection of Wisconsin's next Essential Health Benefits benchmark plan. This delay can be granted via an extension from the federal government, which Citizen Action has learned has been granted to every states who has so far requested it.

An excerpt Rep. Johnson's letter posted on the Wheeler Report:

I am requesting that Wisconsin’s Office of the Commissioner of Insurance request an extension from the Federal Government to ensure adequate public discussion and implementation.

A transparent assessment of the previous EHB benchmark package to identify successful attributes and areas for improvement for consumers is critical to informing the selection of an EHB benchmark for 2017. Moving forward, the EHB benchmark plan should meet Wisconsin consumers’ needs as well as balance health services across the ten mandated essential health benefit categories.

As you know, Wisconsin did not participate in the HHS process for selecting an initial EHB package in 2013, and instead defaulted to the federal rule.

I believe that active public participation in selecting Wisconsin’s EHB benchmark would both benefit Wisconsinites and strengthen Wisconsin’s health insurance markets. The types of plans and levels of benefits available to consumers going forward over the next two years will be determined in large part by how Wisconsin’s EHB package is defined.

In short, decisions about Wisconsin’s EHB benchmark selection are too critical to many to justify remaining a bystander state. In working closely with consumers and learning their experience with their health plans, I believe that areas to assess and address in the next EHB must include limited access to adolescent substance use disorder preventive services, substance use disorder treatment services and mental health services.

Decisions regarding the essential benefits insurance companies must cover must be transparent and include opportunities for meaningful public participation through open meetings, publicly accessible notes, and public comment options. Wisconsin consumer should have a voice in the process of ensuring insurance companies cover the services they need.

We commend Representative Johnson for standing up for health care consumers in Wisconsin. The Walker Administration must act by Monday to take steps to ensure a transparent, consumer friendly selection process.


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