Panel Says There Must be A Limit on Health-Care Benefits to Ensure Affordability

Panel Says There Must be A Limit on Health-Care Benefits to Ensure Affordability



A panel of experts on Thursday suggested that the Obama administration must emphasize affordability over the breadth of coverage when it comes to the implementation of a vital insurance provision of the 2010 health-care law.

Obama officials who are charged with specifying what “essential benefits” many health plans will cover must make it their priority to keep insurance premiums at a reasonable cost, even if such would mean allowing the plans to be less comprehensive. This is what the committee of the National Academy of Science’s Institute of Medicine counseled.

Marjorie Ginsburg, a committee member, said, “The question is what is the fairest, most transparent way to get a reasonable set of benefits and still keep it affordable for both the user and for the taxpayers. We don’t want to say that one is more important than the other. . . But the limiting issue obviously is affordability.”

The committee’s findings emphasized the difficult balancing act that is being faced by the Obama administration in carrying out one of the most sweeping, yet confusing, mandates of the 2010 health-care law. The law specifies ten general categories, which range from hospitalization to prescription medication, that all new insurance plans for small businesses and individuals must offer beginning in 2014. The statute also mandates that the extent of the essential benefits package must be equal to that of a “typical employer plan.”

However, Congress did not indicate whether this provision referred to those generous plans sponsored by big employers or the modest versions that are being bought by a lot of small businesses. This provision also provided Secretary of Health and Human Services Kathleen Sebelius a definitive authority to determine both how detailed the package will be and what is to be included in it.