2012-20

Essential Benefits: Ensuring That Every American Has Access to Vital Healthcare Treatments

AS AMENDED REPRESENTATIVE JOSEPH E. MIRÓ (DE) INTRODUCED NATIONAL SUMMIT HEALTH CARE TASK FORCE

WHEREAS, the Patient Protection and Affordable Care Act (ACA) established and took the first steps in defining a set of core health services, called “Essential Benefits,” which must be covered by all health insurance plans sold through state exchanges; and

WHEREAS, as directed by the ACA, the Department of Health and Human Services (HHS) provided guidance on the Essential Benefits package and proposed that states select from four types of benchmark health insurance plans that reflect the scope of products and services offered by a “typical employer plan.” HHS did not establish standards that would ensure affordability or patient access to a full range of treatments; and

WHEREAS, the design of the Essential Benefits package is critically important and will directly impact the future of patient access to quality health care and the health of all Americans; and

WHEREAS, quality health care for America’s diverse patient populations depends on access to a wide range of health care products and services, including access to a full range of medications which save and improve patients’ lives and enable patients to avoid other alternatives which may be more disruptive, unpleasant, or expensive; and

WHEREAS, affordability is also essential to ensure access and improve health outcomes, since burdensome patient out-of-pocket costs and high copayments can cause people to delay or forgo needed treatment; and

BE IT RESOLVED, that Essential Benefits should ensure access for every American family to affordable, quality health care and should include a wide range of health care products and services that meet diverse patient needs;

BE IT FURTHER RESOLVED, that access safeguards – such as those found in Medicare Part D – should apply to the Essential Benefits package;

BE IT FURTHER RESOLVED, new treatments approved by the FDA should be presumptively included in Essential Benefits packages so that patients can benefit immediately from evolving medical and scientific knowledge, innovations in care, and new technologies;

BE IT FURTHER RESOLVED, that Essential Benefits should ensure that patients and their healthcare providers – not the government or insurance companies – determine the most appropriate course of treatment;

BE IT FURTHER RESOLVED, that patients’ out-of-pocket exposure to Essential Benefits should be affordable, transparent with regards to insurance coverage and cost sharing obligations, and prohibitive of discrimination;

BE IT FURTHER RESOLVED, that the definition of Essential Benefits must guarantee meaningful coverage for all individuals to ensure that all patients, especially vulnerable patients with chronic conditions or other complex treatment needs, have access to medically necessary and appropriate treatments at affordable out-of-pocket costs;

BE IT FINALLY RESOLVED, that the NHCSL Health Care Task Force is also required to form a broader set of principles on Essential Health Benefits to focus on the many other categories of care requiring coverage.

THIS RESOLUTION WAS ADOPTED AND RATIFIED ON NOVEMBER 17, 2012 AT THE NHCSL ANNUAL MEETING HELD IN ALBUQUERQUE, NEW MEXICO.

Sponsored by: Representative Joseph E. Miró (DE)