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Essential Health Benefits: Balancing Affordability and Adequacy

Friday, February 03, 2012

Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered through state insurance exchanges – as well as non-grandfathered plans offered in the individual and small group markets – will be required to cover a set of health benefits and services called the “essential health benefits” package. Guidance issued last month by the Department of Health and Human Services will give each state some discretion to specify benefits within the 10 categories specified in the law.

The implementation of the essential health benefits package raises many questions. What is the task before states in selecting and designing “benchmark” plans that are comprehensive but also affordable? How will states and HHS ensure that benefits are sufficiently standardized so that consumers and employers can make informed choices about plans based on premiums and cost-sharing differences? What does it mean for health plans to have the ability to offer benefits that are “substantially equal” to the benchmark plan? How will states incorporate state benefit mandates? What role will public involvement play in this process? What recommendations did the Institute of Medicine make on ensuring that health plans are affordable over time? Are there opportunities for using the essential health benefits to lower health spending?

To address these and related questions, the Alliance for Health Reform and The Commonwealth Fund sponsored a February 3 briefing. Speakers were: John Santa, Consumer Reports; Janet Trautwein, National Association for Health Underwriters; Chris Koller, Rhode Island health insurance commissioner; and Kavita Patel, Brookings Institution. Ed Howard of the Alliance and Sara Collins of Commonwealth co-moderated.


 Janet Trautwein, National Association of Health Underwriters, Speaker
 Christopher Koller, Rhode Island Office of Health Insurance Commissioner, Speaker
 John Santa, Consumer Reports, Speaker
 Kavita Patel , Brookings Institution , Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Transcript (Word Document), 2/10/2012
Event Summary: Event Summary (Adobe Acrobat PDF), 2/10/2012
Full Webcast/Podcast: Essential Health Benefits: Balancing Affordability and Adequacy

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Sara Collins Presentation (PowerPoint), 2/3/2012
Kavita Patel Presentation (PowerPoint), 2/3/2012
John Santa Presentation (PowerPoint), 2/3/2012
Trautwein Presentation (PowerPoint), 2/3/2012

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda - Essential Health Benefits: Balancing Affordability and Adequacy (Word Document), , 2/3/2012
Speaker Biographies (Adobe Acrobat PDF), , 2/2/2012
Selected Experts - Source List (Adobe Acrobat PDF), , 2/3/2012
Materials List (Adobe Acrobat PDF), , 2/3/2012
National Association of Health Underwriters Press Release (Adobe Acrobat PDF), , 2/3/2012
Event Summary (Adobe Acrobat PDF), , 2/10/2012

Offsite Materials (briefing documents saved on other websites)

Essential Health Benefits: Balancing State Flexibility with Consumer Protections, The Commonwealth Fund, 12/1/2011
- Sara Collins
Essential Health Benefits (Adobe Acrobat PDF),CIGNA, 6/1/2011
Essential Health Benefits Bulletin (Adobe Acrobat PDF),Center for Consumer Information and Insurance Oversight, 12/1/2011
Essential Health Benefits: Illustrative List of the Largest Three Small Group Products by State (Adobe Acrobat PDF),Center for Consumer Information and Insurance Oversight, 1/1/2012
Essential Health Benefits: Key Issues for States (Adobe Acrobat PDF),Choice Administrators White Paper, 12/1/2011
Advisory Panel Says Essential Health Benefits Package Must Be Affordable, Kaiser Health News, 10/1/2011
- Appleby P. Galewitz
New Avalere Health Study Shows that State Decisions about „Essential Health Benefits‟ Could Have Profound Effect on Patient Drug Coverage, Avalere Health, 1/1/2012
- Erica Garland
Defining Essential Health Benefits – The View from the IOM Committee, The New England Journal of Medicine, 10/1/2012
- John Iglehart
Essential Health Benefits Provide Flexibility...For States to Raise Premiums, United States Senate Republican Policy Committee, 12/1/2011
- Chris Jacobs
Implementing Health Reform: A Bulletin on Essential Health Benefits, Health Affairs Blog, 12/1/2011
- Timothy Jost
Letter to Secretary Sebelius from Republican Ranking Members and Chairs of Senate HELP Committee, Senate Finance Committee, House Ways and Means Committee, House Energy and Commerce Committee, an (Adobe Acrobat PDF),, 1/1/2012
Questions About Essential Health Benefits, Kaiser Family Foundation, 10/1/2011
- Claxton Levitt and G.K. Pollitz
Essential benefits guidance vague on who picks the plan, Politico Pro, 1/1/2012
- Jason Millman
Washington Health Policy Week in Review Essential Health Benefits Proposal Prompts Questions, Worries,, CQ HealthBeat, 1/1/2012
- Jane Norman
Essential Health Benefits: Balancing Costs, Coverage, and Necessity, Health Affairs Blog, 12/1/2011
- Kavita Patel
Health Care Law Will Let States Tailor Benefits, The New York Times, 12/1/2012
- Robert Pear
Essential Health Benefits: Policy Considerations, Health Affairs Blog, 12/1/2011
- Kavita Patel
The Essential Health Benefits Provisions of the Affordable Care Act: Implications for People with Disabilities (Adobe Acrobat PDF),The Commonwealth Fund, 3/1/2011
- Sara Rosenbaum et al.
Essential Health Benefits: Comparing Benefits in Small Group Products and State and Federal Employee Plans, Office of Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 12/1/2011
- Laura Skopec et al.
Survey Demonstrates Americans Receive Comprehensive Health Benefits through Employer Plans (Adobe Acrobat PDF),National Association of Health Underwriters, 1/1/2012
Essential Health Benefits (Adobe Acrobat PDF),Cancer Action Network-American Cancer Society, 1/1/2011
- J. Touschner and S. Corlette
A United Patient Voice on Essential Health Benefits (Adobe Acrobat PDF),The National Health Council, 8/1/2011
Essential Health Benefits: Balancing Coverage and Costs, Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans; Institute of Medicine., 10/1/2011
The Intersection of Essential Health Benefits and Medicaid (Adobe Acrobat PDF),Center for Health Care Strategies, Inc, 3/1/2011
- Carolyn Ingram


Janet Trautwein, CEO of the National Association of Health Underwriters, discusses the benefits typically covered in employer-sponsored health insurance and how this relates to essential health benefits to be covered by all insurance sold on state exchanges beginning in 2014. From the Feb. 3 briefing cosponsored by The Commonwealth Fund.

Christopher Koller, Rhode Island commissioner of health insurance, discusses how his state is going about choosing a benchmark health plan covering essential health benefits in plans to be offered on Rhode Island's exchange beginning in 2014. From the Feb. 3 briefing cosponsored by The Commonwealth Fund. (8 min.)

John Santa, director of the Consumer Reports Health Ratings Centers, notes that competition among health plans works only if consumers understand the coverage they have and can compare offerings among plans. From the Feb. 3 briefing cosponsored by The Commonwealth Fund. (10 min.)

Kavita Patel of The Brookings Institution notes that the Affordable Care Act offers guidance on balancing affordability, access and adequacy of benefits in plans to be made available through state exchanges, but does not say exactly how to do this. From the Feb. 3 briefing cosponsored by The Commonwealth Fund. (11 min.)


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