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Summary
Pages 3-12

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From page 3...
... As a result, by 2016, an estimated 30 million indi viduals, who would otherwise have been uninsured, are expected to obtain insurance through the private health insurance market or state expansion of Medicaid programs. To ensure a consistent level of benefits, the ACA calls for certain types of private and public insurance to incorporate a federally determined essential health benefits (EHB)
From page 4...
... FIGURE S-1 Four policy domains with associated foundational principles for thinking about essential health benefits devel opment and implementation. NOTE: EBP = evidence-based practice.
From page 5...
... New S-2 FIGURE S-2 Criteria for assessing content of essential health benefits (EHB) in the aggregate, for specific compo 11/16/11 nents, and for methods.
From page 6...
... The committee considered two basic approaches the Secretary could take to estab lish the initial cost of the EHB: select the market basket of benefit options and then estimate what it would cost or set a cost target and determine what could be purchased within that constraint. The committee endorses the latter BOX S-1 Essential Benefits Categories in the Patient Protection and Affordable Health Care Act Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care SOURCE: §1302(b)
From page 7...
... Recommendation 1: By May 1, 2012, the Secretary should establish an initial essential health benefits (EHB) package guided by a national average premium target.
From page 8...
... A Framework Should Be Developed to Guide Data Collection for Monitoring Implementation and Updating of the EHB The state health insurance exchanges will determine which health plans are qualified to operate in the exchange, and can provide information about the progress of implementing the EHB. The ability of the states to provide consistent and usable information to the Secretary will be enhanced if a framework for collecting and analyzing data is developed in advance.
From page 9...
... Recommendation 3: For states administering their own exchanges that wish to adopt a variant of the fed eral EHB package, the Secretary should use statutory authority to grant such requests, provided that the state-specific EHB definition is consistent with the requirements of Section 1302 of the ACA and the criteria specified in this report, that they produce a package that is actuarially equivalent to the national package established by the Secretary, and that the request is supported by a process that has included meaningful public input. To best achieve this, the Secretary should encourage a public deliberative process as described in this report and should provide technical assistance to the states for implementing that process.
From page 10...
... A public deliberative process should be used to inform choices about inclusions to or exclusions from the updated package, with specific attention to how inclusion of new benefits could affect the availability of existing covered benefits. A Strategy Should Be Developed to Address Rising Costs From the beginning of its deliberations, the Committee unanimously agreed that if the country does not address the problem of health care costs growing faster than the gross domestic product, it will undermine the ACA's goal of substantially reducing the number of people without health insurance.
From page 11...
... For example, the Secretary could co-convene a commission with a representative of the private sector experienced in purchasing health services to develop and implement meaningful actions to control costs. Because coordinated federal action would increase the likelihood of success in the public sector, the Secretary of HHS could coordinate federal participation in a commission and oversee federal implementation of such a commission's recommendations.
From page 12...
... any mechanisms that would enhance the evidence base of the EHB package and its potential for promoting value; and • Advise the Secretary on conducting and using the results of a periodic national public deliberative process to inform its recommendations around updates to the EHB. CONCLUSION The ACA establishes an essential health benefits package and defines 10 general categories that must be included in that package.


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