Essential Health Benefits Not Expected Until Spring

St. Paul, Minn.—A key part of the controversial health care debate in the U.S. is that of “essential health benefits,” or the categories of services that every insurance plan will be required to cover under the health reform law.
Currently, the Affordable Care Act— passed by President Obama and dubbed Obamacare by its opponents—defines 10 broad categories that must be included, such as “ambulatory patient services” and “hospitalizations.” What fits within those categories is up to the Obama administration. Earlier this month, the Institute of Medicine made recommendations on how to determine what is “essential.” And by the end of the year, Health and Human Services will use those recommendations to issue regulations.
Patient advocate Twila Brase, president of Citizens’ Council for Health Freedom, a patient-centered national health policy organization based in St. Paul, Minn. , says that when the government dictates what is “essential” in health care, rather than leaving those decisions up to doctors and patients, a dangerous door is opened.
“Right now, there are 10 broad ‘essential health benefit’ categories listed in the plan,” Brase says, “and the federal decision makers can’t even decide if those 10 should remain, be increased to a very specific list or decreased. And, on par with inefficient government bureaucracy, the list is not due to be complete until at least May—seven months away. How long will it take a patient to get a critical treatment approved that’s not on the list?
“Furthermore, too much time and money is being spent on a government health plan that may not even stand up under the law,” Brase continued. “Right now, the constitutionality of the plan is being challenged and so any further work on Obamacare that is costing taxpayers money should be stopped until we know if the plan will even hold up.”
The essential health benefits decision will be significant for the health industry—from doctors to insurance companies. Any plan that wants to sell in the new insurance marketplace will have to cover the benefits, as well as rank the value of plans.

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