Perspectives on Essential Health Benefits Workshop Report (2012) / Chapter Skim
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2 The Policy Context for Essential Health Benefits
2 The Policy Context for Essential Health Benefits
Pages 17-26
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From page 17... ...
Glied reiterated that beginning in 2014, the EHB are required to be offered by qualified health plans participating in health insurance exchanges,1 insurance plans in the individual and small group markets outside the exchange,2 Medicaid benchmark and benchmark equivalent plans,3 and state basic health programs for low-income individuals not eligible for Medicaid.4 In response to an inquiry from committee member Dr. John Santa, Dr.
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From page 18... ...
Santa, Dr. Glied clarified that ASPE does not expect the IOM committee to identify these commonly used utilization management practices, but said that when the Chief Actuary of the Centers for Medicare & Medicaid Services determines the EHB package is equal in scope to that of a typical employer and determines actuarial value, the actuary "will look at what is actually in practice in the world and make estimates on that basis." Dr.
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From page 19... ...
Instead, the Secretary of HHS was intended to define and update the categories of covered treatments, which, in turn, generally results in coverage for the items and services within broad benefit classes, but with "detailed benefit designs defined in the private market." The Senate Finance Committee, he said, evaluated numerous models when it framed the EHB package. It ultimately rejected fee-for-service (FFS)
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From page 20... ...
As further evidence of the legislature's intent, Mr. Hayes noted that if Congress intended to have a prescriptive benefit package as detailed as the 61 pages of benefits explicated in the Health Security Act, 6 it would be likely that the 60 percent actuarial package (i.e., the ACA's bronze plan)
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From page 21... ...
Spangler, including that the Senate Finance Com mittee aimed to ensure Congress did not "overreach." In 1993, for instance, the Health Security Act included "very specific, very detailed" provisions for the benefit package. Conversely, he said, in "crafting" the ACA, "Congress showed what its proper role is": to define large categories of care, and then allow the executive branch to "do its job implementing the law and dealing with the specific details." Congress intended, he said, "meaningful benefits so that when people get insurance, it will mean that they would really have access to health care." To ensure the scope of the benefits would be "big enough so that people who get insurance through the exchange" have a meaningful package, the Senate Finance Committee "decided to link" the EHB standard to what is offered in typical employer plans.
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From page 22... ...
, and labor unions to "talk about what the benefits package should look like" using four models: the few lines of text in the Massachusetts Health Care Reform Law,9 two amendments promulgated by the Commonwealth of Massachusetts to flesh out the essential benefits defined in that law, 10 and the many pages in the Clinton reform bill.11 These models provided two extremes: the Massachusetts law, he said, is "very, very brief" whereas the Clinton bill involved an enormous amount of detail. The committee intended, he said, for the EHB package description to be "somewhere in the middle." After these discussions with stakeholders, Dr.
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From page 23... ...
Professional field economists employed by BLS contact each selected establishment to sample occupations, capture data on wages and benefits, and obtain copies of plan documents for health and retirement benefits. BLS then analyzes this information to obtain detailed provisions related to health and retirement benefits.
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From page 24... ...
Bureau of Labor Statistics. National Compensation Survey available at http://www.bls.gov/ncs/ (accessed February 8, 2011)
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From page 25... ...
Wiatrowski acknowledged that capturing data from plan documents provided on a voluntary basis limits the information BLS can provide to HHS. Of the categories of additional services HHS asked BLS to investigate, "a number" of these, Mr.
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