Implementation of the Affordable Care Act (ACA) continues this month, especially concerning the creation of health insurance exchanges and the definition of the Essential Health Benefits (EHB), two critical reforms that will be fully implemented in 2014.
The Congressional Research Service, the governmental body that provides research and analysis to Congress, recently released a report on Health Insurance Exchanges. The report provides an overview of the functions of exchanges and how they will be established and administered under the ACA. The report also discusses insurance plans that will be offered through the exchanges and how exchanges will interact with other ACA provisions. For more information on exchanges, watch the webinar NHF conducted in May.
NHF continues to work to ensure that EHBs in each state meet the needs of people with bleeding disorders. One of the most important aspects of EHB rules concerns prescription drug benefits, since plans could be allowed to cover only one drug per category or class. This restrictive formulary would not be sufficient for people with bleeding disorders. NHF has highlighted the importance of a broader formulary in all of its comment letters, which are available here.
The National Health Council (NHC), a membership organization of patient advocacy and other healthcare stakeholders to which NHF belongs, also recently released a statement calling for a broader formulary. An article on the formulary issue and NHC's statement is available here. In the article, NHC COO Marc Boutin reports that his discussions with HHS staff indicate that health plans are likely to be required to include more than one drug per category or class when EHB regulations come out this fall, but more details are not yet known. For more information on EHB and to see the webinar that NHF conducted in April, click here.
Finally, the US Department of Health and Human Services is holding a series of regional stakeholder conference calls this month to discuss the latest information regarding implementation of the health insurance exchanges and strategies to educate the uninsured, under-insured and small businesses about expanded insurance coverage options. Chapter staff and advocates are encouraged to participate in their state's call to learn more about exchanges. There will likely be an opportunity to ask questions and make comments, and we can further emphasize the need for exchanges to be responsive to people with high-cost, rare chronic conditions. Click here for more information on the conference calls and to register to participate in them.