CHARLESTON, W.Va. -- West Virginia officials are questioning another major provision of the federal health-care overhaul, this one calling on states to set basic levels for 10 categories of services that many insurance policies must cover.
Gov. Earl Ray Tomblin wrote U.S. Health and Human Services Secretary Kathleen Sebelius on Friday, posing seven questions regarding benchmarks for essential health benefits.
The federal law will require individual and small employer health plans to cover an array of services starting in 2014. These 10 categories include such mainstays as emergency and hospital care, prescription drugs and doctor visits. They also include maternity and newborn care, services for people with mental health, substance abuse and chronic disease issues, and wellness and preventive care.
Some of Tomblin's questions refer to the absence of federal regulations defining the benefit categories. They also ask how federal officials would react if the state sets benchmarks based on the most common small employer policy in West Virginia, instead of developing its own.
"It is critical to our analysis of essential health benefits that we measure the impact of this federal requirement on our citizens in as accurate a manner as possible, which can only happen through the clarity of final federal rules,'' Tomblin wrote.
Several questions invoke the health care overhaul's provision for expanding Medicaid to more of the working poor. The U.S. Supreme Court decision that upheld the federal law also barred the withholding of funds from states that decide not to expand their Medicaid programs. The ruling prompted Tomblin and other governors to quiz Sebelius over the summer about their states' options, including whether states could count on federal aid if they expand more gradually or stop short of the law's enrollment goal.
Friday's letter said that those Medicaid questions, posed in July, remain unanswered. It questions how essential benefits for private insurance might affect the cost of Medicaid -- considered the biggest driver of state budget growth -- and of the Children's Health Insurance Program.
Sebelius' department sought responses from states by Sunday regarding essential health benefits. Illinois, for instance, chose a plan sold by Blue Cross Blue Shield that is considered relatively lean for its benchmarks.
But the federal overhaul remains in the crosshairs of critics, in the wake of the Supreme Court's 5-4 ruling upholding it. Some governors opposed to the law have put off decisions regarding its provisions, waiting instead for the Nov. 6 election. Republican presidential nominee Mitt Romney has vowed to repeal the act if he is elected.
After narrowly winning a 2011 special election for an unexpired term, Tomblin is running this year for a full, four-year term as governor. Bill Maloney, his GOP opponent then and now, has told voters he'll "repeal Obamacare'' if he wins. Maloney's campaign says that means blocking any attempt to implement the federal law in West Virginia, and working with the state's congressional delegation to repeal the penalty faced by people who don't purchase health insurance. The Supreme Court concluded that penalty is a tax, allowing the overhaul's insurance mandate to pass constitutional muster.