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Drug coverage key sticking point for new health care law

BOSTON --Advocates for small businesses and a coalition representing consumer groups clashed Monday over whether employers should be required to offer prescription drug coverage to comply with the state's landmark health insurance law.

Business leaders warned a prescription coverage requirement and proposed limits on deductibles and other out-of-pocket costs would create too big a burden for small employers, and in some cases leave consumers with coverage that's more expensive than they can get now under existing low-cost private plans.

But a coalition whose members include various consumer groups and public health advocates called prescription drugs a critical piece of any coverage package.

The back-and-forth came as the state panel overseeing the health care law prepares for a March 20 vote on what obligations employers must meet to provide acceptable minimum coverage. Employers with 11 or more workers that don't meet the minimum standard would face an annual fee of up to $295 per employee.

The Commonwealth Health Insurance Connector board earlier this month asked insurers to estimate prices for low-cost insurance plans that don't cover prescriptions to see how costs would compare with plans including drug coverage. The board's staff asked the panel to consider granting approval to plans that wouldn't offer drug coverage.

The group Affordable Care Today, a coalition representing interests including consumer and labor organizations and hospitals, sent the board a letter last week calling prescription drugs "a first line of defense" in fighting disease.

John McDonough, executive director of the group Health Care for All, said in a phone interview that opponents of a prescription coverage requirement "want to allow really low benefit, high cost-sharing plans that don't meet the basic needs of our workers.

"It's kind of a 'duh' issue -- good medical care today includes prescription drugs," McDonough said.

Supporters of a drug coverage requirement held a news conference Monday, while opponents sent a letter to Jon Kingsdale, director of the agency implementing the law, saying certain proposed minimum coverage requirements hurt small employers and ultimately could "increase the number of uninsured, not reduce it."

The group cited data presented Feb. 8 by Connector board staff that more than 200,000 people statewide now have health plans that don't include prescription coverage, or provide such coverage only after the consumer has paid a deductible.

"The proposed standards that have been discussed would leave individuals and small businesses with fewer options, and force them to purchase more expensive coverage," the letter said.

The letter was signed by groups representing the state's retailers, restaurants, convenience stores and liquor stores; five local chambers of commerce; and the Greater Boston Convention & Visitors Bureau.

The state's biggest business lobby, Associated Industries of Massachusetts, did not sign. But AIM's president and CEO, Richard Lord -- who also is a member of the Connector board -- said his business organization also opposed mandating prescription coverage.

Under the state's health care law approved last year, all residents are required to have health insurance by July 1 or face tax penalties. An estimated 160,000 to 200,000 people are uninsured and do not qualify for state-subsidized plans.

The goal is to produce health care plans that offer solid coverage but can be afforded by anyone earning more than three times the federal poverty rate -- or about $29,400 for an individual.