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Blair Horner: September is a Big Month for Health Care Reform

Labor Day, the symbolic end of summer, has come and gone.  Schools have opened and children are off to new classes and teachers.

But this September is an important month for another reason: this is the month when New York, as well as all other states, must choose the “essential health benefits” that will be offered to those who lack health insurance.

The federal health care reform law, the Affordable Care Act, established a minimum floor of services that all health plans in the individual and small group markets will be required to cover starting in 2014, called the essential health benefits (EHB).  This important provision of the health care law is meant to ensure that all individuals and families are guaranteed coverage for certain essential health services, regardless of which health plan they choose.

The Affordable Care Act included 10 broad categories of services that the essential health benefits package must cover.  However, the law left it up to the federal government’s Department of Health and Human Services (HHS) to define exactly what items and services will be covered within these broad categories and at what scope.

Earlier this year, HHS issued its opinion on the scope of health services included in the essential health benefits for the first couple of years.  Rather than create one federal definition, HHS gave each state the authority to define exactly what items and services will be included in its essential health benefits package in 2014 and 2015. 

For 2014 and 2015, New York – as will all states – must create an EHB package based on 4 benchmark plan options.  In New York, those plans include the Empire Plan, which offers coverage for New York State public employees, the Oxford plans, and Blue Cross Blue Shield.

By the end of September, the Cuomo Administration will choose which of these plans is best for consumers.  In addition to the richness of the benefits offered, the state will have to consider the cost.

Each of the benefit packages would cost slightly more in order to offer coverage that meets the standards required under the Affordable Care Act.  For example, according to analyses by the Cuomo Administration, Oxford Plan benefits would result in one percent increase in medical costs, with the Empire Plan benefits projected to see an increase of nearly 4.5 percent.

Obviously, the choice of which health benefits package is not one just based on cost, it’s about the coverage itself.

For people with chronic health conditions – like cancer – the EHB decision is critically important.  For cancer patients, lack of insurance can be deadly.  Research suggests that approximately 10 percent of cancer patients are uninsured at the time of diagnosis.  About one-third of cancer survivors report a loss of health insurance at some point in time since their diagnosis.  Uninsured patients are less likely to get recommended cancer screenings and are more likely to be diagnosed with cancer at later stages.

For those reasons, many consumer advocates have urged the Administration to choose the Empire Plan’s coverage as the essential health benefits for New Yorkers.  The Plan offers comprehensive coverage, particularly for those who have chronic illnesses – and for those who may someday have a chronic illness – meaning all of us.

Here’s hoping that the Cuomo Administration makes the right choice.

Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division. His commentary does not necessarily reflect the views of the American Cancer Society.

The views expressed by commentators are solely those of the authors, and do not necessarily reflect the views of this station or its management.