Affordable for Consumers and Employers
By Karen Ignagni, President and CEO, America’s Health Insurance Plans
For decades, health insurance plans have helped individuals, families, and small businesses strike the right balance among affordability, access, and comprehensive coverage. With the Institute of Medicine expected to issue recommendations to HHS this week about which “essential benefits” should be included in health plans that will be offered through new exchanges, this experience holds important lessons for policymakers.
In the commercial marketplace, health plans work with employers and health benefits advisors to determine which benefits or level of benefits will be covered; how much they will contribute to the cost of services; and how they may access medical care through the plan. Through this process, health plans are able to respond and adapt to the varying needs and preferences of employers and consumers. Other programs, such as the Federal Employee Health Benefits Program and the Massachusetts Exchange, rely on this same framework in designing their benefits. Benefit packages are regularly assessed, updated, and refined.
In the Affordable Care Act, Congress identified ten categories of “essential” services or items that should be included in any plan’s benefit package offered through the exchange. These categories were designed to be broad enough to ensure coverage is comprehensive while still giving individuals and small businesses flexibility to choose the type and amount of coverage they can afford to purchase. If the essential benefits package goes beyond Congress’ intent and prescribes rigid elements of the benefit structure, such as number and frequency of services that should be covered, it will be putting at risk affordable coverage for millions of Americans – and breaking one of the central promises of health reform.