People who hoped to influence Institute members spoke during two public events earlier this year. Not surprisingly, rifts emerged among the speakers over issues of cost and coverage. For an overview of comments to the IOM from employer groups, consumer advocates, former state officials and Congressional staffers who worked on the Affordable Care Act over issues of cost and coverage, you can read a summary report.
Medical care not deemed “essential” could be excluded from coverage. For households, health plans that leave out or limit services may leave patients underinsured, a description policy-makers use for those with insurance who nonetheless struggle with significant financial burdens from medical care.
Hospitals and doctors say a growing number of the insured swamped by medical bills means more write-offs and patients who delay medical care until it cannot be avoided.
Premiums, however, reflect the scope of health plan benefits. Employers and individuals could be priced out of health plans that have a sweeping reach. Two congressional health policy staffers during the 2009-2010 health reform debate who worked under Republican senators told the IOM to consider small business plans—which are often less comprehensive than large employer insurance—as “typical” employer coverage. Essential health benefit must be similar to those offered by typical employers.
David Bowen, former health policy staff director of the Senate Health, Education, Labor and Pensions committee, argued for more expansive benefits. Bowen, who served the Democratic-led committee during the health reform debate, said “typical” should mirror benefits of generous large employers.
The IOM committee gave no indication of its recommendations in the summary and stressed speakers voiced their own opinions, not the IOM's.
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