Essential Health Benefits: Balancing Affordability and Adequacy

February 3, 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.


Full Transcript (Adobe Acrobat PDF)

Speaker Presentations

Sara Collins Presentation (PowerPoint)
Kavita Patel Presentation (PowerPoint)
John Santa Presentation (PowerPoint)
Janet Trautwein Presentation (PowerPoint)

Event Details

Agenda (Adobe Acrobat PDF)
Speaker Biographies (Adobe Acrobat PDF)

Event Resources