The money that patients’ rights advocates have to spend trying to convince the Obama administration that Americans should have decent health care benefits pales in comparison to the boatloads of cash insurers and their corporate allies have on hand to do largely the opposite. But at least the advocates are now in the game.
Last week a broad coalition of patient-focused groups launched its “I Am Essential” campaign in an effort to make sure that when all of us have to buy health insurance in 2014, we will be getting good value.
When Congress passed the Affordable Care Act last year, it included a provision requiring that all health insurance plans sold a little more than two years from now must contain “essential health benefits.” It established 10 categories of required coverage: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management and pediatric services, including oral and vision care.
The Department of Health and Human Services has the responsibility of determining, with input from the respected nonprofit Institute of Medicine, just how comprehensive the coverage will have to be in each of those categories.
Insurers and employers who offer coverage to workers have been lobbying both the IOM and HHS to make the coverage requirements as narrow as possible. They want to continue marketing plans with skimpy benefits because they are less costly to employers and potentially more profitable to insurers. The problem with that approach, of course, is that millions of ...