i Gerald W. Mefintec
President

Lee A. Saunders
Secretary Treasurer
Vice Presidents

Ken Allen
Portland, OR

Henry L. Bayer
Chicago IL
George Boncoragllo
NewYork NY
‘Anthony Caso
Boston, MA
Grog Devereux
‘bmp, WA
Danny Donohue
‘Abany, NY
David R.Fillman
‘Hrrisburg, PA
Michael Fox
orrisburg, PA
Albert Garratt
Detrot, Mi
Raglan George Jt.
‘New York, NY
Sherryl Gordon
Trenton, N}
Lakesha Harrison
okland, CA
Danny J. Homan
Des Moines, iA
Salvatore Luciano
New Briton, CT
John A. yal
Worthington, OH
Roberta Lynch
Chicago, I
Glenard $. Middleton Sr.
Battimore, MD
Gary Mitchell
‘Madison, WI
‘Veronica Montgomery-Costa,
‘New York, NY
Doug Moore
Son Diego, CA
Henry Nicholas
Philedelphio, PA
Eddie Parks
Westerville, OH
Randy Perreira
Honolua, Hi
George E.Popyack.
Oakland, CA
Greg Powell
‘Austn,TX
Laura Reyes
San Diego, CA
Eddie Rodriguez
NewYork, NY
Lawrence A, Rochrig
Lonsing, MI
Joseph P.Rugola
Columbus, OH
Kathy J-Sackrman
Pomona, CA
Eliot Seide
South St Poul, MN
Mary E Sullivan
‘Albany, NY
Braullo Torres
San juan, PR

David Warrieke
Iedfonapois,

Jeanetce D. Wynn
“allohassee, FL

Gia 2510

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AFSCME.

| We Make America Happen

August 26, 2010

Office of Consumer Information and Insurance Oversight
Department of Health and Human Services

PO Box 8016

Baltimore, MD 21244-1850

Attention: OCIIO-9994-IFC

Re: Interim Final Rule Relating to Preexisting Condition Exclusion,
Lifetime and Annual Limits, Rescissions and Patient Protections
45 CER Parts, 142, 146, 147
RIN 0991-AB69

Ladies and Gentlemen:

Iam writing on behalf of the American Federation of State, County & Municipal
Employees (AFSCME), a union of 1.6 million active members and retirees throughout
the United States. AFSCME appreciates this opportunity to comment on the Interim
Final Rule regarding Preexisting Condition Exclusion, Lifetime and Annual Limits,
Rescissions and Patient Protections under the Patient Protection and Affordable Care
Act (PPACA).

AFSCME has fought to improve our health care system for decades and through
the tremendous energy and commitment of our members, activists and leaders all over
the country we played an important role in the passage of the PPACA. Because our
members have fought and sacrificed for their health benefits coverage won at the
bargaining table, one of our main health care reform objectives was to maintain and
improve existing health coverage. We believe that these regulations help to address this
goal. We offer the following comments in an effort to suggest improvements in the
regulations in order to facilitate the achievement of the statutory objectives of the
PPACA.

Specifically, AFSCME believes the regulation governing application of annual
and lifetime limits should prohibit group health plans, and insurance issuers, from
applying any limitation on annual or lifetime benefits for essential health benefits other
than the annual dollar limits allowed during the transition period. Failure to do so will
defeat the intent of PPACA because plans and issuers may simply replace current dollar
limits with numeric limits on services. Such limits most commonly take the form of
limits on inpatient days, physician office visits, outpatient procedures, numbers of
diagnostic tests or procedures, etc. Clearly the intent of the law was to end all such
limitations on essential health benefits. Section 147.126 should be changed
accordingly.

American Federation of State, County and Municipal Employees, AFL-C1O

TEL (202) 429-1000 FAX (202) 429-1293 “TDD (202) 659-0446 WEB wwwafscme.org 1625 L Street, NW, Washington, DC 20036-5687



Office of Consumer Information and Insurance Oversight
August 26, 2010
Page 2

In addition, group health plans and insurance issuers should be expressly prohibited from
establishing dollar or numeric service limits on any sub-category of essential health benefits. A
single, aggregate, annual limit on such benefits may be applied during the transition period.
Thereafter, no limit may be applied to any essential health benefit. Section 147.126 should be
changed accordingly.

Finally, if a group health plan or insurance is granted a waiver from the restricted annual
limits in §147.126(d)(1) in accordance with (d)(3), the health plan or insurance that obtains such
a waiver should not be considered qualifying employer sponsored coverage for a dependent
under age 26 so that such dependent may be determined to be ineligible for coverage under a
grandfathered employer sponsored health plan or insurance.

We appreciate your consideration of the foregoing and your efforts on behalf of the
nation’s health care consumers.

Sincerely,

baka

Steven Kreisberg
Director of Collective Bargaining
Health Care Policy

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