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Essential health benefits : balancing coverage and cost /
Cheryl Ulmer ... [et al.], editors ; Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans, Board on Health Care Services, Institute of Medicine of the National Academies.
imprint
Washington, D.C. : National Academies Press, c2012.
description
xxiii, 231 p. : ill. ; 28 cm.
ISBN
0309219140, 9780309219143
format(s)
Book
Holdings
More Details
added author
imprint
Washington, D.C. : National Academies Press, c2012.
isbn
0309219140
9780309219143
contents note
Introduction -- Approaches to determining covered benefits and benefit design -- Policy foundations and criteria for the EHB [Essential Health Benefits] -- Resolving ACA [Affordorable Care Act] intent -- Defining the EHB -- Public deliberation -- Program monitoring and research -- Allowance for state innovation -- Updating the EHB.
abstract
"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."--Publisher's description.
catalogue key
8472663
 
Also available online.
Includes bibliographical references.
A Look Inside
Reviews
This item was reviewed in:
Reference & Research Book News, December 2012
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Summaries
Description for Bookstore
An estimated 50 million people in 2010 were uninsured in the United States. The Patient Protection and Affordable Care Act of 2010 (ACA) is intended to help uninsured Americans obtain health insurance. To ensure a more consistent level of benefits, the ACA requires that certain insurance plans--including those participating in the state purchasing exchanges--cover a package of diagnostic, preventive, and therapeutic services and products that have been defined as "essential" by the Department of Health and Human Services (HHS). An estimated 30 million individuals, who would otherwise have been 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.This package constitutes a minimum set of benefits that the plans must cover, but insurers may offer additional benefits. The ACA requires that the EHB include at least 10 general categories of health services, and have benefits similar to those currently provided by a typical employer. Essential Health Benefitsrecommends a process that would help HHS define the benefits that should be included in the EHB, and update the benefits to take into account advances in science, gaps in access, and the effect of any benefit changes on cost. This book does not decide what is covered in the EHB, but rather proposes a set of criteria and methods that should be used in deciding what benefits are most important for coverage. The benefits included in the EHB must be sufficiently inclusive to enable access to essential services but must also be affordable so that as many as possible can purchase the coverage. This report is of value to ASPE and other HHS agencies, state insurance agencies, congress and state governors, health care providers, consumer advocates.
Description for Bookstore
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 Benefitsrecommends 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.
Long Description
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.

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