By Kate Nocera
Politico
January 18, 2011

It’s at meetings like the Institute of Medicine’s Committee on the Determination of Essential Health Benefits where these groups (AHIP and others) can begin to voice their concerns. The committee convened for three days last week to hear from experts, lobbyists and special advocacy groups. The IOM will soon make recommendations to the Department of Health and Human Services on what defines an “essential benefit” that insurers must cover if they want to be listed on the exchanges that are coming in 2014.

Carmella Bocchino, AHIP executive vice president of clinical affairs and strategic planning, asked HHS not to load specific benefits into the bill, so the 10 broad categories of benefits would remain as they are and the market would decide what type of coverage is needed. The group also asked HHS not to include the 2,000 state mandates as part of an essential benefit package. Each state directs insurance providers on what must be covered in the policies they sell. The inclusion of every state mandate in the health care reform law would significantly drive up consumer costs and mandates for all states, which does not necessarily make sense, AHIP argues.

http://www.politico.com/news/stories/0111/47711.html

IOM meeting on essential benefits:
http://iom.edu/Activities/HealthServices/EssentialHealthBenefits/2011-JAN-12/Agenda.aspx

Comment: 

By Don McCanne, MD

The Institute of Medicine (IOM) will be making recommendations to HHS on the definition of required essential benefits for the health plans that are to be offered through the state insurance exchanges. Several experts testifying before IOM’s Committee have called for flexibility in the definition (testimonies provided at IOM link above).

We should all be concerned that the insurance industry intends to use this approach to “let the market decide what type of coverage is needed.” Although the health reform legislation closed large loopholes in insurance coverage, it is clear that the industry fully intends to use innovations in essential benefit design to continue to profit by depriving patients of essential health care.

It was a terrible mistake to design health care financing reform based on the existing model of private insurance plans. No matter how much the private insurers are regulated, they will always find a way to place their own interests first.

It is not too late to stop this nonsense and do it right – establish our own publicly-administered and publicly-financed single payer national health program, an improved Medicare for all.

Health care lobby mum on repeal

By Kate Nocera
Politico
January 18, 2011

It’s at meetings like the Institute of Medicine’s Committee on the Determination of Essential Health Benefits where these groups (AHIP and others) can begin to voice their concerns. The committee convened for three days last week to hear from experts, lobbyists and special advocacy groups. The IOM will soon make recommendations to the Department of Health and Human Services on what defines an “essential benefit” that insurers must cover if they want to be listed on the exchanges that are coming in 2014.

Carmella Bocchino, AHIP executive vice president of clinical affairs and strategic planning, asked HHS not to load specific benefits into the bill, so the 10 broad categories of benefits would remain as they are and the market would decide what type of coverage is needed. The group also asked HHS not to include the 2,000 state mandates as part of an essential benefit package. Each state directs insurance providers on what must be covered in the policies they sell. The inclusion of every state mandate in the health care reform law would significantly drive up consumer costs and mandates for all states, which does not necessarily make sense, AHIP argues.

http://www.politico.com/news/stories/0111/47711.html

IOM meeting on essential benefits:
http://iom.edu/Activities/HealthServices/EssentialHealthBenefits/2011-JAN-12/Agenda.aspx

The Institute of Medicine (IOM) will be making recommendations to HHS on the definition of required essential benefits for the health plans that are to be offered through the state insurance exchanges. Several experts testifying before IOM’s Committee have called for flexibility in the definition (testimonies provided at IOM link above).

We should all be concerned that the insurance industry intends to use this approach to “let the market decide what type of coverage is needed.” Although the health reform legislation closed large loopholes in insurance coverage, it is clear that the industry fully intends to use innovations in essential benefit design to continue to profit by depriving patients of essential health care.

It was a terrible mistake to design health care financing reform based on the existing model of private insurance plans. No matter how much the private insurers are regulated, they will always find a way to place their own interests first.

It is not too late to stop this nonsense and do it right – establish our own publicly-administered and publicly-financed single payer national health program, an improved Medicare for all.