Empowering patient voices through voter registration
While roughly 83% of adults in the United States will visit a health care provider in the next year, an estimated
News
10-13-11 Affordable Care Act Update
October 18, 2011
Institute of Medicine Releases Report on Principles for Essential Benefits Package
Last week the Institute of Medicine (IOM), an independent scientific research body, released its report on principles for an essential benefits package. One of ACS CAN's most important goals is to achieve adequate health coverage for all cancer patients. The Affordable Care Act gives the Secretary of Health and Human Services very broad - but vague - authority to develop an essential health benefits package. The IOM report is a thorough first attempt to define how such a package should be defined when it takes effect in 2014, as well as how a process should be established to review and revise the package in future years as more information and evidence becomes available.
The most significant recommendation involves HHS setting a "target premium" based on a "typical" health insurance plan provided by a small employer today. In 2014, the health exchanges will be providing coverage almost exclusively to people in the individual and small group market. Therefore, IOM argues that using a typical small employer plan as an initial benchmark is a reasonable starting point for a "silver plan". (Note that a "silver plan" will have an actuarial value of 70 percent; it is the second lowest of four tiers ranging from 60-90 percent actuarial value. Premium subsidies in the exchanges will be based on the cost of a silver plan.) Based on the premium target, HHS would determine what benefits must be offered that would meet the target premium and the coverage requirements of the ACA (the law only specifies 10 broad categories of benefits that must be provided).
The report specifically recommends that existing state mandates not be given special consideration in developing the benefit package. The report authors argue that many, if not most, mandates are not based on significant analytical or scientific review. However, because of the requirement in the law that requires new plans to cover USPSTF "A" and "B" recommendations, evidence-based cancer screenings will almost certainly be required to be included in any package.
The IOM report addresses many other important issues related to essential benefits, including much greater data collection and disclosure to inform patients and providers about the extent and quality of coverage; better information systems to enhance the use of evidence-based care and treatment; the importance of appeal rights and a clear definition of medical necessity to protect patients' rights; and the importance of assessing medical innovations to improve care while containing costs.
Overall, the report represents a very important step forward in defining this crucial piece of health care reform. ACS CAN and other consumer groups will try to meet with administration officials in the coming weeks to further our advocacy work and better understand how HHS intends to proceed with developing a proposed regulation for an essential benefits package.
Dr. Seffrin Testifies Before Senate Health Committee on Chronic Disease Prevention
Dr. John Seffrin joined leaders from the American Diabetes Association and American Heart Association on Wednesday to testify before the U.S. Senate Committee on Health, Education, Labor and Pensions on the need for a health care system that better incorporates, coordinates and values quality and prevention. Dr. Seffrin, a member of the federal Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, testified that a unified focus on prevention that includes individual efforts, contributions from government and initiatives by nonprofits is the only way this problem can be addressed. Coverage for preventive screenings, the creation of the National Prevention Strategy and initiatives supported by the Prevention and Public Health Fund are key elements of this approach. Any cuts to the Prevention and Public Health Fund would undermine our nation's ability better focus our health care system on health and wellness.
Read Dr. Seffrin's testimony and ACS CAN's press release.
HHS Issues Warning About PCIP Private Site
HHS is warning consumers about a private website that is acting as the official source for information about pre-existing condition insurance plans, according to Politico Pulse. The site, http://preexistingconditioninsuranceplan.com, has a small disclaimer at the bottom of the homepage that explains it is not a government site, but HHS is asking people not to submit any personal information to the site "under the assumption that it is a government website." For information about the PCIP program, individuals are encouraged to visit www.pcip.gov or call 866-717-5826.
As always, thank you for all you do every day to support laws and policies that help cancer patients and their families.
Christopher W. Hansen
President
American Cancer Society Cancer Action Network (ACS CAN)