A council charged with implementing health care reform in Maryland on Thursday chose a state employee plan as the base line for all small group and individual insurance plans sold in the state from 2014 through 2016.
“This is a small but important step for us,” said Dr. Joshua Sharfstein, secretary of the Department of Health and Mental Hygiene. “There are still so many other pieces of the puzzle to be put in place.”
Sharfstein co-chairs with Lt. Gov. Anthony G. Brown the Maryland Health Care Reform Council, created in 2010 to move the state toward implementing the federal government’s Affordable Care Act.
Maryland has been out front of many other states in moving to adopt provisions of the health care reform law.
Part of the law is that all health care insurance plans have to cover a minimum set of benefits — called essential health benefits — starting in 2014, including emergency services, maternity care, mental health and substance abuse services and pediatric dental and vision care.
The U.S. Department of Health and Human Services required each state to choose their own benchmark plan, from a list of 10 options already sold in the state.
“It’s a very comprehensive set of benefits,” said Carolyn Quattrocki, the executive director of the governor’s Office of Health Care Reform. “The idea is to have health care insurance be meaningful.”
The plan chosen includes coverage for in vitro fertilization, one of the most expensive services covered under the plan. The council voted to submit the plan to the U.S. Department of Health and Human Services with an emphasis on the insurance provider’s ability to swap out the in vitro fertilization coverage for a comparable — but less expensive — service.
“We’re very mindful of the costs of all this,” Quattrocki said.
An estimate of the total cost of insurance — either for an employer who purchases a plan or an individual covered by the plan — can’t be determined yet because, Quattrocki said, there are a number of factors that will determine the ultimate cost.
It also was unclear Thursday evening how many state employees currently are under the plan that was selected as a base line.
Because the federal government has yet to make certain rules governing the implementation of the law, unanswered questions remain, including whether insurance providers will be able to swap out services like in vitro fertilization for less expensive ones.
The plan, which is one of several state employee options, also covers perscription drugs. Additional services such as pediatric dental and vision care, which are not usually covered under the plan, had to be added.
Another question up in the air is what will happen in 2016, when the federal government is slated to put out its own benchmark plan.
“But they could say, ‘Well, this is working well, so keep doing what you’re doing,’” Quattrocki said. “In that case, they [the benchmark plan selected Thursday] could keep going in 2016.”
The plan will now go to the Department of Health and Human Services for a public comment period and approval.