Administration Takes Heat Over Essential Benefits Guidance

Two authors of the Institute of Medicine report on essential health benefits criticized the Department of Health and Human Services’ pre-bulletin guidance granting states greater flexibility in designing essential health care benefits, arguing that the administration’s approach represented a “missed opportunity” for ensuring health insurance affordability. “By giving the states the option to pick the various plans, they in essence said any of the state mandates would be OK,” John Ball, chairman of the IOM essential benefits committee told Politico. In October, the IOM had recommended that HHS establish a premium target — “setting a dollar amount for coverage and then filling in the benefits to meet the limit” — or use “medical effectiveness to select benefits. Interestingly, an editorial in this morning’s Des Moines Register also notes that a federal standard would establish greater uniformity across the country and “guarantee a diabetic or autistic child had equal coverage, regardless of where they lived.” “It makes sense for the federal government to set details, because billions of federal dollars will be used to help pay for these insurance plans,” the paper says. “Also, compared to elected officials, executive branch workers are relatively free from the influences of special interests.”