In The Spotlight

Essential Health Benefits: Balancing Affordability and Adequacy

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? 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 recommendations did the Institute of Medicine make on ensuring that health plans are affordable over time? To address these and related questions, the Alliance for Health Reform and The Commonwealth Fund are sponsoring a February 3 luncheon briefing. Read More

The 9 million beneficiaries dually eligible for Medicare and Medicaid are generally poorer and sicker than other Medicare beneficiaries, tend to use more health care services, and thus account for a disproportionate share of spending in both programs. Many deficit reduction plans under recent discussion have recognized the need to improve care for this population and provide care in a more cost-effective way.How do Medicaid and Medicare coordinate payment and care for people covered by both programs? Are HHS initiatives encouraging innovations to integrate care for dual eligible beneficiaries? What kinds of programs are currently available? What do consumers think about fee-for-service plans, special needs plans or other programs in which they are currently enrolled? What lessons for program design can policy makers learn from the attitudes of consumers? To answer these and related questions, the Alliance for Health Reform and the AARP Public Policy Institute sponsored a December 12 briefing.  Read More

The Budget Control Act of 2011 tasked six senators and six representatives, from both sides of the aisle, to find at least $1.2 trillion in deficit reduction over the next decade. After weeks of deliberation, members of the “Super Committee” did not reach an agreement by the November 23 deadline. As a result, automatic spending cuts to defense and social welfare programs are set to kick in beginning in January 2013, leaving many questions about the short-term and long-term consequences of the committee’s failed negotiations. How will Congress and the executive branch react, especially in the context of a Presidential election campaign? What impact will a sequester have on the health care sector? Is Congress likely to devise alternatives by 2013, given such vast differences among lawmakers? How will implementation of the Patient Protection and Affordable Care Act be affected? To address these questions and more, the Alliance for Health Reform and four cosponsors presented a December 2 briefing. Read More

Medicaid currently provides health and long-term care to 68 million Americans, and the Patient Protection and Affordable Care Act would significantly expand Medicaid beginning in 2014. As a countercyclical program, Medicaid typically faces increased enrollment at the same time that states are looking to cut their budgets. Although the Budget Control Act of 2011 exempts safety-net programs like Medicaid from across-the-board cuts, Medicaid has remained a keenly debated topic in discussions of how to reduce the deficit. Which proposals affecting Medicaid might receive serious consideration by the “super committee” in its quest to find $1.2 trillion or more in savings by its November 23 deadline? What impact would these changes have on the populations served by this program, providers, and states? To address these questions and more, the Alliance for Health Reform and four cosponsors presented a November 10 briefing. Read More