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Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act

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  • Haeder, Simon F.

Abstract

The Essential Health Benefits provisions under the Affordable Care Act require that eligible plans provide coverage for certain broadly defined service categories, limit consumer cost-sharing, and meet certain actuarial value requirements. Although the Department of Health and Human Services (HHS) was tasked with the regulatory development of these EHB under the ACA, the department quickly devolved this task to the states. Not surprisingly, states fully exploited the leeway provided by HHS, and state decision processes and outcomes differed widely. However, none of the states took advantage of the opportunity to restructure fundamentally their health insurance markets, and only a very limited number of states actually included sophisticated policy expertise in their decisionmaking processes. As a result, and despite a major expansion of coverage, the status quo ex ante in state insurance markets was largely perpetuated. Decisionmaking for the 2016 revisions should be transparent, included a wide variety of stakeholders and policy experts, and focus on balancing adequacy and affordability. However, the 2016 revisions provide an opportunity to address these previous shortcomings.

Suggested Citation

  • Haeder, Simon F., 2014. "Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act," Health Policy, Elsevier, vol. 118(3), pages 285-291.
  • Handle: RePEc:eee:hepoli:v:118:y:2014:i:3:p:285-291
    DOI: 10.1016/j.healthpol.2014.09.014
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    1. Calltorp, Johan, 1999. "Priority setting in health policy in Sweden and a comparison with Norway," Health Policy, Elsevier, vol. 50(1-2), pages 1-22, December.
    2. Reinhard Busse & Tom Stargardt & Jonas Schreyögg, 2005. "Determining the “Health Benefit Basket” of the Statutory Health Insurance scheme in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 30-36, November.
    3. Ham, Chris, 1997. "Priority setting in health care: learning from international experience," Health Policy, Elsevier, vol. 42(1), pages 49-66, October.
    4. Summers, Lawrence H, 1989. "Some Simple Economics of Mandated Benefits," American Economic Review, American Economic Association, vol. 79(2), pages 177-183, May.
    5. Busse, Reinhard, 1999. "Priority-setting and rationing in German health care," Health Policy, Elsevier, vol. 50(1-2), pages 71-90, December.
    6. Gruber, Jonathan, 1994. "State-mandated benefits and employer-provided health insurance," Journal of Public Economics, Elsevier, vol. 55(3), pages 433-464, November.
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    Cited by:

    1. Nour Kattih & Fady Mansour & Franklin G. Mixon, 2021. "Keeping what you like: grandfathering and health insurance coverage take-up rates under the ACA," Journal of Economics and Finance, Springer;Academy of Economics and Finance, vol. 45(1), pages 188-199, January.

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