In 2010, an estimated 50 million people were uninsured in the United States. A portion of the uninsured reflects unemployment rates; however, this rate is primarily a reflection of the fact that when most health plans meet an individual's needs, most times, those health plans are not affordable. Research shows that people without health insurance are more likely to experience financial burdens associated with the utilization of health care services. But even among the insured, underinsurance has emerged as a barrier to care.
The Patient Protection and Affordable Care Act (ACA) has made the most comprehensive changes to the provision of health insurance since the development of Medicare and Medicaid by requiring all Americans to have health insurance by 2016. An estimated 30 million individuals who would otherwise be uninsured are expected to obtain insurance through the private health insurance market or state expansion of Medicaid programs. The success of the ACA depends on the design of the essential health benefits (EHB) package and its affordability.
Essential Health Benefits recommends a process for defining, monitoring, and updating the EHB package. The book is of value to Assistant Secretary for Planning and Evaluation (ASPE) and other U.S. Department of Health and Human Services agencies, state insurance agencies, Congress, state governors, health care providers, and consumer advocates.
Institute of Medicine. 2012. Essential Health Benefits: Balancing Coverage and Cost. Washington, DC: The National Academies Press. https://doi.org/10.17226/13234.
|2 Approaches to Determining Covered Benefits and Benefit Design||25-46|
|3 Policy Foundations and Criteria for the EHB||47-58|
|4 Resolving ACA Intent||59-78|
|5 Defining the EHB||79-102|
|6 Public Deliberation||103-114|
|7 Program Monitoring and Research||115-128|
|8 Allowance for State Innovation||129-134|
|9 Updating the EHB||135-152|
|Appendix A: Patient Protection and Affordable Care Act, Section 1302, and Web Questions for Public Input||153-158|
|Appendix B: Stakeholder Decisions on Health Insurance||159-168|
|Appendix C: Examples of Possible Degrees of Specificity of Inclusions in Small Group and Individual Markets||169-190|
|Appendix D: Examples of Benefit Package Statutory Guidance||191-196|
|Appendix E: Description of Small Group Market Benefits, Provided by WellPoint||197-208|
|Appendix F: General Exclusions||209-224|
|Appendix G: Medical Necessity||225-232|
The Chapter Skim search tool presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter. You may select key terms to highlight them within pages of each chapter.
A new Institute of Medicine report provides the U.S. Department of Health and Human Services with a set of criteria and methods to develop a package of essential health benefits that will cover many health care needs, promote medically effective services, and be affordable to purchasers. The package will establish the minimum benefits that certain health insurance plans must cover under the Patient Protection and Affordable Care Act.
The National Academies Press (NAP) has partnered with Copyright Clearance Center's Rightslink service to offer you a variety of options for reusing NAP content. Through Rightslink, you may request permission to reprint NAP content in another publication, course pack, secure website, or other media. Rightslink allows you to instantly obtain permission, pay related fees, and print a license directly from the NAP website. The complete terms and conditions of your reuse license can be found in the license agreement that will be made available to you during the online order process. To request permission through Rightslink you are required to create an account by filling out a simple online form. The following list describes license reuses offered by the National Academies Press (NAP) through Rightslink:
Click here to obtain permission for the above reuses. If you have questions or comments concerning the Rightslink service, please contact:
Rightslink Customer Care
Tel (toll free): 877/622-5543
To request permission to distribute a PDF, please contact our Customer Service Department at 800-624-6242 for pricing.
To request permission to translate a book published by the National Academies Press or its imprint, the Joseph Henry Press, pleaseclick here to view more information.