By Tom Wilemon, The Tennessean
Some of the sickest people in Tennessee had angels willing to take
on the devil in the details Tuesday as the state held its first public
hearing on what benchmarks insurance plans will have to meet under terms
of the Affordable Care Act.
Advocates for people with multiple
sclerosis, AIDS and mental illness told Commerce and Insurance
Commissioner Julie Mix McPeak what the level of coverage should be for
those conditions. Others spoke in favor of hearing aids for deaf
children and infertility treatments for couples trying to conceive a
The meeting at Vanderbilt University concerned the
"essential health benefits" provision of the law, which is intended to
protect people from being under-insured. These rules will apply to
individual policies and small-employer group plans, including those
offered through the state insurance exchange after Jan. 1, 2014. The
federal law, often referred to as Obamacare, directs that these plans
have the same level of coverage as those typically offered by a large
employer. But the law leaves it up to the states to set those
"We're not here to discuss Obamacare or TennCare or
the health insurance exchanges today," McPeak said, stressing that the
hearing concerned a "narrow and specific section" of the massive law.
have 10 basic plans currently offered by large employer groups from
which to choose a benchmark, but they can modify whichever reference
plan they choose. McPeak is soliciting public input until Aug. 10 and
will then submit a recommendation to Gov. Bill Haslam, who will make a
final decision on the state benchmark plan and send it to the U.S.
Department of Health and Human Services by a Sept. 27 deadline.
Interrante, chief executive officer of Nashville CARES, was the first
advocate who spoke. He came with a written statement that outlined
standards of care for people with HIV and AIDS.
Sita Diehl, an
official with the National Alliance on Mental Illness, suggested that
the state consider using the federal employee BlueCross BlueShield
plan's mental health coverage as the benchmark.
"It does have substantial and adequate mental health benefits," Diehl said.
people, including Chris Coleman of the Tennessee Justice Center,
brought up the issue of hearing aids for children over concerns that
Tennessee may not provide this coverage because it may have to bear more
of that cost than with other benefits.
Mary Littleton, a
Nashville lawyer who has battled multiple sclerosis for 10 years, said
she cannot afford insurance on the private market and that she and
thousands of other Tennesseans with the disease need access to a plan
with adequate coverage.
"Given that no two people with M.S. are
alike and that it is so unpredictable to live with M.S., we have to
purchase insurance with the worst-case scenario in mind," Littleton
The state employee health plan PPO should be the benchmark for people with multiple sclerosis, she said.
The five other public hearings
are set for July 31 in Kingsport and Knoxville, Aug. 1 in Cleveland and
Aug. 3 in Memphis and Jackson. People can also submit written comments.
states have authority to determine coverage benchmarks, the federal law
does require that benefits be provided for hospitalizations, pediatric
dental care, outpatient services, emergency visits, maternity and
newborn care, mental health, laboratory tests and wellness services,
including chronic disease management.