STUDY: States Aren’t Struggling To Expand Insurance Benefits Under Obamacare


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States and insurers are in the process of finalizing the plans that will be sold on Obamacare’s insurance marketplaces beginning in October. And the process is going forward with few troubles or cost increases despite a requirement in the health law that individual policies provide a broader range of benefits than they typically do today, according to a new study.

Obamacare requires insurers selling plans on its statewide marketplaces to cover ten broad “essential health benefits” categories. These include things typically included in insurance plans — such as doctor’s visits — as well as less common items like children’s dental care and “habilitative” therapy services for the developmentally disabled. Skeptics of the health law predicted that this requirement would be burdensome to insurance companies and raise plan prices as a consequence.

But that’s not what researchers at the Urban Institute and the Robert Wood Johnson Foundation found to be the case in states like Colorado, New Mexico, and Oregon. Despite complex administrative requirements, “most companies were able to meet federal and state filing deadlines and insurance departments have implemented practical approaches to manage the significant expansion” of benefits, the authors wrote.

Although many insurers were already required to offer some of the more expansive essential benefits by state laws, almost every one of them had to add children’s dental and vision coverage and therapy services for the disabled under Obamacare. And as it turns out, that’s mostly gone off without a hitch.

“Overall the states in our review are managing the shift to essential health benefits well,” said Andy Hyman of the Robert Wood Johnson Foundation in an interview with The Hill. “In these states, health plans offered through exchanges will offer coverage options that are comprehensive and high-quality, and will be offered at an affordable price.”

One area where the researchers urged caution was with therapies and treatments for the disabled. Although Obamacare sets up the broad essential benefits categories, it largely leaves what specific services will be covered under those categories to the states. And when it comes to the habilitative services, some insurance companies and state officials are concerned that the vague benefit requirements may produce policies that don’t adequately serve consumers’ needs. As consequence, the authors said that “it will be important for state officials to monitor [consumers’] access to care in order to determine the extent to which their coverage meets their needs.”