User-friendly health plan summaries at risk

Associated Press
Thursday, January 26, 2012


WASHINGTON — Consumer groups are scrambling to salvage a popular provision of President Barack Obama’s health care overhaul that suddenly seems to be in question.

This time it’s not Republican opposition they’re worried about, but the White House itself.

At issue is a requirement that health plans provide simple, standard summaries of coverage and costs to help consumers pick benefits that are right for them — a sort of “CliffsNotes” version of cryptic insurance company jargon.

Consumer advocates say they fear the administration may heed industry complaints that the regulation as proposed last summer is too costly, burdensome and intrusive. The rule is due to take effect this year and is undergoing final review by the White House. It would apply to all private and employer health plans, covering an estimated 180 million Americans.

“There is concern that the consumer protections we were hoping to see may not be in the final rule,” said Dr. LaShawn McIver, policy director for the American Diabetes Association. “Ultimately, we are looking for a consumer-friendly product that gives people the information they need about what levels of coverage they can expect.”

Her organization and four others — the American Cancer Society, the American Heart Association, AARP and Consumers Union — wrote Obama this week urging him not to water down the requirements.

“The information available to Americans today is wholly inadequate for consumers to choose and understand the insurance coverage options available to them,” their letter said.

Simple-to-understand health plan summaries are the most popular provision of the health care law, which otherwise continues to divide the public. That’s according to a poll last November by the nonpartisan Kaiser Family Foundation, which found the summaries garnered support from 84 percent of Americans compared with 37 percent who viewed the overall law favorably.

Administration officials said they can’t comment on the specifics of regulations under review, but they sought to reassure the consumer groups, which were among the major backers of the health care law as it was being debated in Congress.

“Giving consumers the information they need and making the health care system more transparent is a top priority,” said Erin Shields, a spokeswoman for the Health and Human Services Department. “We’re confident the final rules … will meet that goal.”

A proposed template released by the department last summer included such basic details as information on premiums, deductibles and copays for doctor visits and hospitalization. Such information is now generally the norm in health plan summaries that most companies voluntarily provide their employees during annual open enrollment.

But the federal template also included so-called coverage examples of the cost of care for a typical individual for three common health conditions: normal childbirth, treating breast cancer and managing diabetes. Because all health plans would have to follow the same rules in compiling the information, it would allow consumers to directly compare insurance in ways they can’t now.

America’s Health Insurance Plans, a trade group representing the industry, complained that the timeline for introducing the comparisons this year is unrealistic, and the cost would be more than double what the government estimated, or $382 million for the first two years alone. That would drive up costs for employers and health plans, the industry said, at a time when many companies are struggling in a difficult economy.

Lynn Quincy, a senior policy analyst for Consumers Union, said the advocacy groups have learned that the requirement for employer plans to provide the comparisons may be delayed or weakened. Additionally, two of the coverage examples may be omitted at least initially, leaving only a comparison of maternity costs.

“We are very concerned that compared to the proposed rule that was released in August, the final rule we are expecting shortly will be weakened,” she said. “That would be very bad for consumers.”