Essential Benefits? What Essential Benefits.

Roger Collier

Posted 12/22/11 on Health Care Reform Update

Last week’s announcement from the Obama administration that it would not now define a single uniform set of “essential health benefits” to be provided by all insurers undoubtedly took most health care policy observers by surprise.

The Department of Health and Human Services’ decision to allow individual states to specify benefits within broad categories means that there could be significant variations across the nation, and smacks more of election year political pandering than practical policy. Although criticism of the decision was relatively muted, it may be one that leaves both consumers and employers unhappy.

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Essential Health Benefits: Policy Considerations

Kavita Patel

Posted 12/28/11 on the Health Affairs Blog

In the recently released bulletin from HHS on the essential health benefits (EHB), the administration answered a major question on the minds of many critical healthcare stakeholders: Will the administration be specific in their guidance and create a definition of what constitutes “essential?” The answer, is no, they will leave the bulk of the decision-making to the states, thus increasing the likelihood of variation in benefits and access to elements of care.

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Implementing Health Reform: A Bulletin on Essential Health Benefits

Timothy Jost

Posted 12/16/11 on the Health Affairs Blog

On December 16, 2011, HHS released a “bulletin” describing the approach that it intends to take to establishing the “essential health benefits” under the Affordable Care Act. A bulletin is a form of guidance that lacks the legal stature of a rule. HHS believed, however, that the states, insurers, consumer advocates, and the public needed some indication as to the direction HHS was intending to take in defining the EHB, and the Bulletin was intended to serve this purpose until an actual rule is issued.

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Essential Health Benefits: Balancing Costs, Coverage and Necessity

Kavita Patel

Posted 10/14/11 on the Health Affairs Blog

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 care

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