In December 2011 the Department of Health and Human Services surprised just about everyone when it announced via a bulletin that instead of establishing essential health benefits (EHB) at a federal level for the state health insurance exchanges, it was considering passing that job onto the states.
The immediate reaction was generally negative with consumer groups and some industry stakeholders expressing concern that the state approach would result patchwork interpretations of EHB. Political observers were more pragmatic, suggesting that HHS punted on the EHB decision in an attempt to blunt potential Supreme Court case arguments that the federal government was taking over the country's healthcare system.
The public was invited to formally comment on the bulletin but in an unusual step, the bulletin comments were not collected through the typical regulations.org site. Instead stakeholders and interest groups were directed to an e-mail address. There was no response to a HealthLeaders Media request that HHS identify the central location where all the comments are now stored.
But the comments have been leaking out via e-mail and press releases. Here is a sampling:
Several House committees, including Energy and Commerce and Ways and Means, along with Sen. Mike Enzi (R-WY) and Sen. Orrin Hatch (R-Utah) asks HHS to justify its decision to issue a bulletin rather than a proposed rule on EHB. HHS "is sidestepping several important disclosure requirements with the new healthcare law and is preventing Congress and the American public from being able to assess the true costs associated with the so-called essential health benefits."