On the Right Track: Institute of Medicine’s Essential Benefits Report

by | Oct 7, 2011 | Reproductive Rights

America’s women and families want and need confidence that when they buy health insurance, it will cover comprehensive benefits that meet their needs. Thanks to health reform, we may soon get that.

The new law charged the U.S. Department of Health and Human Services with determining exactly what services should be considered “essential benefits” that must be covered by health insurance. To help Secretary Kathleen Sebelius shape this package, the Institute of Medicine (IOM) created a committee to recommend a process and methodology for defining the essential benefit package – because how that package is designed, and what is included and excluded, will help determine whether reform delivers on its promise.

The committee’s report, released today, is hugely promising. It proposes a process for determining essential benefits that is a balanced approach that prioritizes public involvement. Women and families will have a say, helping to ensure that the final package reflects their needs and values.

A primary aim of the Affordable Care Act (ACA) is to ensure that women and families can access better, more reliable coverage for a range of health care needs – from prevention to women’s health services to coverage of chronic conditions and more. The IOM committee’s report aims to do that and to strike a balance between comprehensiveness of coverage and cost.

We are pleased that the committee recommended that the essential benefits package not be used simply as a cost containment tool. Rather, members recognized that we must look at the broader picture of how to address skyrocketing health care costs. We urge the Secretary to not only consider the short term costs of any given benefit, but the long-term value of a package that pays for the items and service that women and families need to get and stay healthy.

Women will be better off if the Secretary establishes an essential benefits package that includes reproductive health services, care coordination and palliative care. We are especially hopeful that the package will cover maternity care, well-woman and well-child visits, cancer screenings and the full range of reproductive health services and supplies. We want to see care coordination and primary care fully covered. We hope it will to cover language access services, which have the potential to drive down costs associated with the unnecessary care that is common for limited English proficiency patients.

Importantly, the committee today also recognized that our definition of what constitutes an essential benefit may change in the future. We applaud the creation of the National Benefits Advisory Council, an independent, non-partisan advisory group comprising a variety of stakeholders – including consumers – to update the essential benefit package over time.

The work the IOM committee has done is good for women and for all consumers, but now we need to encourage the Administration to adopt its recommendations. Only then can we ensure that those who need help the most can access the health care they need – which is, after all, what reform is all about.

To learn more, go here and here.