Essential Health Benefits: Balancing Costs, Coverage, And Necessity
The much anticipated Institute of Medicine Report on essential health benefits (EHB) was released last week with a series of recommendations that answered some questions and raised many more. The report offers a very important opportunity for researchers, policymakers, providers and patients to fill in some of the white space between the recommendations.
Background on EHB in the Affordable Care Act and some Legislative History
The Affordable Care Act (ACA) tasked the IOM to make recommendations on the methods for determining and updating the essential health benefits that must be offered by qualified health plans seeking to participate in exchanges as defined in section 1301 of the statute . The ACA identified ten categories of items and services that must be included in a package of benefits:
Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision careThe Affordable Care Act did not have a conference committee report, which is the product of the House and Senate working to resolve differences between the two chambers’ versions and also helps to highlight legislative intent. So the long history of the decisions behind the language and legislative intent is not as apparent. Briefly, Congress looked at many design models and previous bills, such as HR 3600 — one of the health reform bills put forward during the Clinton administration — which contained 61 pages of details on benefits. This approach was was felt to be too detailed and prescriptive.  Staff from Senator Kennedyâs Health, Education, Labor and Pensions Committtee used the Massachusetts language on exchange benefits and its promulgated regulations and then made important additions such as habilitative services (educational or long term services, often associated with long terms disabilities or conditions such as autism).
Health Insurance Cost Average - News
But in the data that we do have, most of it comes down to medical costs. Flip through the filings and you see that, on average, insurers attribute about 60 to 70 percent of any given insurance rate increase to the growing cost of delivering health care
Individual policyholders will see their December bills credited $135 on average, while a family of four will get a $420 average credit, reducing their annual insurance costs by 4.5%. Although Thursday's action affects only nearly 2 million of Blue
For reference, in 2010, the average premium for small group health care coverage was $426 per month, or $5107 annually, for single coverage, and $1117 per month, or $13409 annually, for family coverage, according to America's Health Insurance Plans.
In 2006, the year the Massachusetts law was passed, the average premium was 16 percent higher than the national average. Premiums are well above the national average in Massachusetts — a state known for its Cadillac health care — but that was the
At the state and municipal levels, uncontrolled health-care cost growth hugely impacts budgets. Medicaid is among the top three largest expenses in most state budgets and on average accounts for 22 percent of state expenditure. To a great extent,
Average Cost Health Insurance: What is Normal?Guide to Auto ...
The United States has done a commendable job, as far as insuring its citizens are concerned. The United States is among the nations in the world that has the highest number of citizens insured health wise. Despite this commendable achievement, a certain section of the population is still not insured.
This means a large set of problems for the specific population section and also for the nation broadly. Other than the people who are not insured at all, there are also people who are under insured. Both categories, in varying degrees are vulnerable to financially insecure future.
Let us take a look at the implications of no insurance and under insurance. First, an individual with of no insurance or under insurance can be denied suitable treatment facilities when the individual is faced with a contingency as the treatment costs cannot be financed.
Second, when an individual is faced with a situation where the treatment costs need to be met out of own pocket or savings, this means a drain on the savings and a possible taking away of funds which could have been invested on more productive avenues. Hence, the individual loses out on monetary as well as real terms. Health insurance could have easily averted this situation.
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Third, if the individual is required to finance the treatment costs institutionally because the average cost health insurance cannot be met, the amount needs to be repaid with interest. This means a huge drain on the resources of the individual. Now, let us take a look at the possible reasons for under insurance or over insurance.
First, the average cost health insurance can at times become prohibitive and prevent everyone from subscribing to a health insurance policy. With the cost of insurance multiplying by the day, paying higher premiums for a medical insurance policy can at times be a real challenge.
Second, there is an acute lack of awareness among the people about the benefits of medical insurance. People are at the same time not aware of the inconvenience and the hassles of not having a health insurance policy. Even if the awareness grows at a later stage, people find it difficult to pay the hefty premiums and sustain the health insurance policy for a long period of time.
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