The eagerly awaited report, Essential Health Benefits: Balancing Coverage and Cost, from the Institute of Medicine’s Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans was released on October 6. The report proposes criteria for the U.S. Department of Health and Human Services (HHS) to use in determining the essential health benefits package (EHB).
Though the report is the outcome of a challenging exercise by the committee, it is only the initial step in what the committee itself described as a “politically and socially charged endeavor.”1
The committee recommended that HHS achieve the following milestones:
- May 1, 2012: An initial EHB package will be developed by HHS using the “national average premium target” as a guide, as well as the benefits of what a “typical” small employer offers today. Adjustments should be made “so that the expected national average premium for a silver plan with the EHB package is actuarially equivalent to the average premium that would have been paid by small employers in 2014 for a comparable population with a typical benefit design.” A public process should be implemented to guide the adjustment process.
- January 2013: HHS should have developed a plan for monitoring the implementation of the EHB including mechanisms for sharing data.
- 2015: A public process should be implemented to guide the updating of the EHB package.
Other important recommendations outlined in the report include:
- Promoting state innovation and allowing those states that administer exchanges to modify the EHB package as long as it is consistent with the federal framework;
- Establishing a National Benefits Advisory Council to provide oversight; and
- The implementation of a strategy which will take into account the growth of the rate of health care spending and assure that it is aligned with the growth in the nation’s economy.
HHS will be taking the recommendations into account and will be issuing final rules in 2012.
1Institute of Medicine Committee on Defining and Revising an Essential Health Benefits Package for Qualified Health Plans. Report on essential health benefits: balancing coverage and costs. Washington, DC: National Academies Press, October 7, 2011.
