Archive for the 'Reform' Category

Keeping “Wellness” from Turning into Discrimination

Published on May 8, 2013 in Health Care, Judith Lichtman, Reform and Workplace Fairness. 0 Comments

Judith L. Lichtman, Senior Advisor

Today, I had the honor of testifying before the U.S. Equal Employment Opportunity Commission (EEOC) on a topic of critical importance to our nation’s workers: employer wellness programs. These programs can offer women and families meaningful avenues for improving and maintaining their health. And, as part of the Affordable Care Act, employers will soon have new incentives to establish them. But they can also open doors to discrimination.

Employer wellness programs are aimed at promoting healthier lifestyles and improving health outcomes by encouraging health-related activities like signing up for gym memberships, taking health education classes, getting health risk assessments and more. They come in two basic forms: “participatory” wellness programs, which are available to employees regardless of a person’s health; and “health-contingent” wellness programs, which are tied to certain health benchmarks or targets. It’s the latter that cause concern.

There is no one-size-fits-all approach to individual health, wellness and life circumstances, and employer wellness programs must reflect that. That’s why they should be voluntary, carefully designed, and not tied to health indicators. Groups like women, older adults and racial minorities experience significant health disparities. Tying wellness program penalties to their health situations can cause them disproportionate harm and, as I argued today, violate nondiscrimination laws.

Health-contingent wellness programs that increase health care costs for certain workers aren’t about wellness; they are about shifting costs to working people, especially those with health problems. And there’s no scientific evidence that shows they do anything to improve health outcomes. That’s why the National Partnership is recommending that the EEOC:

  1. Issue specific and thorough guidance to employers to inform them of best practices in designing and implementing wellness programs, as well as potential legal implications;
  2. Engage in outreach and education to employers to help ensure compliance with nondiscrimination laws;
  3. Enforce the law by challenging employer wellness programs that are discriminatory; and
  4. Work with other agencies – including the Departments of Treasury, Labor, Justice and Health and Human Services, and the Office of Personnel Management – to provide the assistance employers need to prevent discrimination in the implementation and regulation of employer wellness programs.

At the National Partnership, we know that access to affordable, quality health care is essential for women and families. We also know the importance of ensuring people can work free from discrimination. Today, I made clear that, with proper oversight, wellness programs can do both: They can help women and families achieve meaningful improvements in their health, without running afoul of our nation’s civil rights laws. We will do all we can to ensure this happens.

You can read my full written testimony here.

It’s All in the Details: Employer Wellness Programs Can Help or Harm

Published on March 22, 2013 in Health Care, Kirsten Sloan, Reform and Workplace Fairness. 0 Comments

Kirsten Sloan, Vice President, National Partnership

As health care purchasers, consumers, and decision makers for ourselves and our families, women are keenly interested in wellness and preventing illness.  So the new wellness programs some employers are offering have some appeal.

These programs are intended to provide a convenient way for employees to improve and maintain their health.  And there are some benefits.  If designed and implemented properly, wellness programs can offer flex-time for walking or other physical activity, provide education about healthy lifestyles and other valuable health-related workplace initiatives.  The programs can also help workers achieve their wellness goals by providing activities at a time and location that fits the time constraints associated with responsibilities at home and in the workplace.

But done badly, employer wellness programs can become a back door way of discriminating by circumventing the market reforms and protections put in place by the Affordable Care Act (ACA).

The National Partnership for Women & Families is working to ensure that wellness programs are not used to undo the progress made by the ACA. In a recent letter to the U.S. Department of Labor, the National Partnership outlined some of the specific steps that need to be taken to ensure that employer wellness programs help — not hurt — women. These steps include:

  • Preventing employers from using workplace wellness programs to tie health insurance premium costs to conditions like weight, cholesterol, and blood sugar levels.  Programs that do this could be used by employers to avoid the ACA’s prohibition on medical underwriting.
  • Ensuring that employers cannot dramatically vary employee premiums so that employees who are unable to satisfy their workplace’s wellness targets face substantially higher premiums.  These employees could find themselves priced out of employer-sponsored coverage, a development that would undermine the intent of many of the ACA’s key insurance reforms.
  • Ensuring employees are fully informed about any financial responsibility associated with wellness programs.  No employee should have to wonder if there is a financial obligation that comes with participating or choosing not to participate in an employer wellness program.

To read the National Partnership’s full letter on the proposed rules for designing and implementing employee wellness programs, go here.

If Budgets Reflect Priorities…

Published on March 19, 2013 in Debra Ness, Health Care, Medicaid, Quality, Reform and Reproductive Health. 0 Comments

Debra Ness, President, National Partnership

If our budgets reflect our priorities, what does Paul Ryan’s budget say about our country, how much we value women and our compassion for the most vulnerable among us? Nothing good, I am afraid.

The Ryan budget that the House of Representatives will vote on tomorrow is driven by misplaced priorities, short-sighted goals, and callous disregard for women and everyone who relies on government programs. It targets close to two-thirds of its cuts to programs that support those with low or moderate incomes, most of whom are women.

The Ryan budget would undermine Medicare’s promise of affordable, quality health care by turning Medicare into a premium support “voucher” program that shifts costs onto beneficiaries, the majority of whom are women who live on less than $22,000 per year.

It would block-grant Medicaid and cut Medicaid funding, endangering health care for millions of women and their children. It would jeopardize care for older women living in nursing homes, putting even greater burdens on family caregivers, most of whom are women. And since Medicaid is the largest source of family planning funds, it would make it harder for millions of women to access the birth control they need.

And the Ryan plan to repeal the Affordable Care Act would cause grave harm to millions of women and their families. Repealing the law would eliminate women’s access to essential preventive services like breast cancer screening, take away young women’s ability to stay on their parents’ health insurance plans until age 26, and eliminate critical protections against gender-based discrimination in insurance coverage and pricing. It would reverse our progress in improving care coordination, which reduces costs for family caregivers and millions of women who suffer from multiple chronic conditions.

The Ryan budget would also devastate nutrition assistance programs, denying millions of families living in or near poverty – many headed by women – the ability to put food on the table. It would put school lunch, child nutrition, job training and child care tax credit programs on the chopping block. It would devastate the safety net.

Rep. Ryan named his budget the “Path to Prosperity,” but it is a path to poverty for millions of women and families. Every representative should vote to defeat this callous budget bill.

At Long Last, Preventive Care Will Be Affordable for All Women, Thanks to Health Reform

Published on July 31, 2012 in Health Care, Judith Lichtman and Reform. 1 Comment

Judith L. Lichtman, Senior Advisor

The Affordable Care Act is the greatest advance for women’s health in a generation, and tomorrow one of its promises becomes reality for millions of women, who will be healthier and better off as a result.

Tomorrow, on August 1, the Affordable Care Act will ensure that new insurance plans cover preventive health care without the cost sharing and co-pays that for too long have put these critical services out of reach for so many women.  This is one of the most tangible and meaningful benefits from reform.

Thanks to the Affordable Care Act, no longer will women go without birth control because they cannot afford the co-pays.

Thanks to the Affordable Care Act, no longer will women go without the HIV and sexually transmitted disease screening and testing that they urgently need.

Thanks to health reform, no longer will cost prevent pregnant women from being tested for gestational diabetes.

Thanks to health reform, no longer will cost prevent new mothers from getting the counseling, support and supplies they need to breastfeed their infants and give them a healthier start in life.

Thanks to reform, no longer will teens and adults at risk for domestic violence go without potentially life-saving screening and counseling.

It’s about time.

Already, the Affordable Care Act has covered women’s annual breast exams, mammograms and pap tests at no cost.  Tomorrow, the list of the law’s benefits expands dramatically as cost ceases to be a deterrent to the preventive care that millions of women need.  And soon, reform will outlaw gender discrimination in pricing – at long last.

It’s hard to believe that controversy still surrounds a law that is doing so much good, that there are those who still try to argue that it should be repealed or defunded.  As more and more benefits roll out, we should all focus on implementing the law and ensuring that all women – and all Americans – can access these critical advances.

To those who try to argue that repealing reform is right for the country or its families, I say this: You can’t talk fast enough, sow enough confusion, or in any other way deceive the women of America – and the men who care about them – any longer.  Better care for pregnant and nursing mothers; screenings for HIV, sexually transmitted infections, and domestic violence; and no-cost access to birth control and other preventive services will make women and our country healthier.  And starting tomorrow, we have the Affordable Care Act and its champions to thank for that.

The Affordable Care Act improves women’s health.

There’s No Place Like (A Medical) Home

Published on May 23, 2012 in Health Care, Lee Partridge, Quality and Reform. 0 Comments

Lee Partridge, Senior Health Policy Advisor

Today, fully 1/3 of our health care spending is wasted on payments for medical mistakes and poor quality care. We also have a system that values expensive technology over basic primary and preventive care, rewards volume of care over outcomes or appropriate care, and makes no distinction in payment based on quality or health outcome. But thanks to the Affordable Care Act, things are looking up.

The health care reform law is advancing a promising approach to addressing these problems: the “Patient-Centered Medical Home.” At the National Partnership, we consider medical homes to be one of the most promising models for delivering truly patient-centered care — they improve access to primary care, help coordinate patient care across settings and providers, and make patients, family caregivers and providers partners in making decisions about care.

Recently, I spoke with the American Academy of Pediatrics about the potential of patient-centered medical homes, how families can get involved in improving quality, and how practices can support patients as partners in care. Take a look!

 

Older Women’s Stake in Health Reform

Published on April 3, 2012 in Debra Ness, Health Care and Reform. 4 Comments

 

Debra Ness, President, National Partnership

Cross-posted from the Huffington Post.

This week, all the talk in Washington has been about handicapping the outcome of the Supreme Court health reform cases, and identifying winners and losers. What did the justices mean with each question? Which way are the potential swing votes leaning? Will the Court reach consensus of any kind? What are the likely political/electoral consequences of the upcoming rulings?

There’s been painfully little attention to the impact of the rulings for patients, and one group has been just about totally ignored throughout this debate: older women. But as one of the most vulnerable segments of our population, older women have a tremendous amount at stake as the future of reform is decided.

Why, when most seniors are covered by Medicare? Because older women tend to have low incomes and poor health — and because nobody suffers more in our fragmented, incoherent health care system.

Let’s get specific. Older women are more likely than others to have chronic conditions and, consequently, they bear the brunt of shortcomings in our health care system — among them high cost, poor quality and uncoordinated services that often generate additional cost, burden and sometimes serious harm. Older women also are more vulnerable than men to high costs, due to the lower wages and savings that result from time spent out of the workforce to meet family caregiving responsibilities.

That means older women gain a lot from the Affordable Care Act, because the law does so much to improve both the affordability and quality of health care.

It is closing gaps in Medicare coverage. Annual wellness visits are now covered, as are some preventive benefits older women need, such as mammograms and bone density tests, without co-pays. This benefit includes time for health care providers to conduct comprehensive health risk assessments and create personalized prevention plans for their patients.

Older women will save millions of dollars as reform closes the current gap in Medicare prescription drug coverage known as the “donut hole.” Beneficiaries who fell in this gap have already received a $250 rebate. Beginning last year, they benefited from 50 percent off brand-name drugs in the “donut hole.” By 2020, the donut hole will be closed, and beneficiaries will only have to cover 25 percent of the cost of their drugs until they hit the catastrophic cap, after which they will only have to pay 5 percent.

Health reform also created the Center for Medicare and Medicaid Innovation, to test, evaluate and rapidly expand new care delivery models that improve quality and care coordination. It encourages the use of health information technology in these models to help improve coordination and communication among health care providers and patients. It puts more resources into making sure older women get the follow-up support they need when they transition from a hospital stay back to the community. It supports new medication management services that will help patients and caregivers understand their medications and avoid dangerous interactions and medical errors. It supports better primary care and a team-based approach that will help older women avoid unnecessary hospitalizations and link them to community services that can help them maintain their health and live better quality lives. And the reform law establishes Geriatric Education Centers to support training in geriatrics, chronic care management and long-term care issues for family caregivers, as well as for health professionals and direct care workers. Read even more about the benefits for older women in health reform here.

Health reform is the greatest advance for women’s health in a generation. Access to affordable, quality health care is central to the well-being of older women. It is a key determinant of their quality of life, their economic security and their ability to thrive, prosper and participate fully in our society. Losing reform would have grave consequences for women and families, and older women have a particular stake. Nobody wins when we lose sight of that.

10 Things to LOVE About the Affordable Care Act

Published on March 21, 2012 in Debra Ness, Health Care, Reform and Reproductive Health. 1 Comment

Debra Ness, President, National Partnership

This week, the Affordable Care Act (ACA) turns two. Let’s not mince words: This law is the greatest advance for women’s health in a generation. Here are just a few things we love about the law:

1. Being a woman is no longer a pre-existing condition.

For the first time in history, gender discrimination will be prohibited in all federally funded health care. This basic protection means that any insurance companies receiving federal funds (including tax credits, subsidies and contracts) will be prohibited from discriminating against women.

2. The ACA helps to make health insurance more affordable for women.

Health care we can afford? Sign us up! The ACA establishes protections to make private health insurance options more affordable for women purchasing coverage on their own or through small businesses.  This is due to new rules to keep premiums in check and prohibitions on charging higher premiums based on gender and health status or history.  Beginning in 2014, lower-income women and families who don’t receive insurance through their employers will be able to access financial assistance to help them buy insurance in the individual market.

3. Women will be guaranteed preventive services such as birth control, mammograms and cervical cancer screenings, with no deductibles or copays. Need we say more?

New private insurance plans will be required to cover a wide range of recommended services without cost-sharing, including well-women visits; screenings for gestational diabetes, osteoporosis, and colon cancer; pap smears and pelvic exams; STI and HIV screenings and counseling; all FDA-approved contraceptive methods; breastfeeding support, counseling, and supplies; and screenings and counseling related to interpersonal violence.  Private plans also must cover screenings and vaccinations critical to children’s health without out-of-pocket costs. The ACA also requires Medicare to waive cost-sharing for many of these services as well provide a free annual, comprehensive wellness visit that includes personalized prevention planning services.

4. Young adults can stay on their parents’ insurance policies until age 26

To ensure that recent high school and college graduates aren’t without coverage as they search for work and start their careers, the ACA allows young adults to stay on their parents’ insurance plans until they are 26 years old. This provision is already benefitting 2.5 million young adults, including an estimated 1.1 million young women.

5. Universal maternity coverage

Currently, most individual health plans fail to provide any insurance coverage for maternity care. This means that even without complications, women face expenses that average $10,652 or more. Beginning in 2012, plans offered in the individual and small group market will be required to cover maternity and newborn care – ensuring better health for mothers and babies.

6. Closing the “donut hole”

Senior women will save thousands of dollars as reform closes the Medicare prescription drug coverage gap. Each year, about 16 percent of Medicare beneficiaries hit the “donut hole” in their prescription drug coverage, meaning that they are responsible for paying 100 percent of drug costs up to the point when Medicare begins to pay again. Under the ACA, a typical Medicare beneficiary who hits the donut hole could save more than $3,000 by 2020, when the donut hole will be closed completely.

7. Expanded Medicaid coverage for lower-income women

Restrictive state eligibility rules have long kept many women from accessing the benefits of Medicaid, which provides essential care over the spectrum of women’s lives. In 2014, the ACA will close this gaping hole in the nation’s safety net by expanding Medicaid eligibility to individuals and families with household family incomes up to 133 percent of the Federal Poverty Level (FPL). With this change, ten million more women will qualify for Medicaid’s comprehensive health coverage with strong out-of-pocket cost protections.

8. Pre-existing condition? The ACA has you covered.

Today, it can be nearly impossible to access health insurance on the individual market without a blemish-free medical history. Health plans deny or drop women from coverage for conditions ranging from acne to C-sections to breast cancer. The ACA already prohibits private health insurers from retroactively canceling coverage when a person incurs high health care costs.  Beginning in 2014, new private health plans will no longer be able to turn away women and families applying for or renewing coverage.  Nor will they be able to exclude services from coverage on the basis of a pre-existing condition. These protections went into effect for children under age 19 in September 2010. To help uninsured adults with pre-existing conditions access coverage before 2014, new Pre-Existing Condition Insurance Plans (PCIP) are available in every state.

9. Higher quality, better coordinated care  

It’s about time!  By investing in primary care, patient safety, and the new Center for Medicare and Medicaid Innovation, the ACA lays the groundwork to improve quality and coordination of care. This means older patients will be less likely to experience dangerous drug interactions, duplicative tests and procedures, conflicting diagnoses, and preventable readmissions.

10. Investment in the health care workforce to ensure access to health care providers

The ACA requires insurance plans to contract with essential community providers, including women’s health centers, HIV/AIDS clinics, community health centers, and public hospitals that serve medically under-served and low-income populations. This will mean women who rely on these clinics can continue to receive care from their regular health care providers, and it will help alleviate the shortage of primary care providers, which is expected to worsen as reform increases the number of people with insurance coverage.  In addition, the ACA establishes Geriatric Education Centers (GECs) to support training in geriatrics, chronic care management, and long term care issues for family caregivers, as well as health professionals and direct care workers. The GECs are required to train family care practices into their curricula.

The ACA is already beginning to deliver for women and their families – and some of the best is yet to come. But the health reform law faces challenges in Congress, in the states and at the Supreme Court.  We can’t let opponents distort the facts, control the debate, or take away a law that America’s women need!  So let’s keep talking about all the ways the Affordable Care Act is helping women.  Let’s ensure we can continue the progress.

It’s time to protect our care – and protect the law.

Welcome Progress, But the Final Verdict on ACOs Is Yet to Come

Published on October 28, 2011 in Debra Ness, Health Care, Reform and William Kramer. 2 Comments

Debra Ness, President, National Partnership

Last week, the Centers for Medicare and Medicaid Services (CMS) may have done what once seemed impossible.  Its final rule on Accountable Care Organizations (ACOs) seems to have put an end to the rancor and bitter debate on this particular issue, shaping a framework that just about all parties can accept.

By responding thoughtfully to comments on the proposed rule, and balancing competing interests, the agency has given us a welcome respite from the pitched battles that are raging over so many aspects of health reform.  But the real measure of success will be whether successful ACOs are soon in place, providing better-coordinated, more patient-centered care for millions of patients and giving us all a way to get better value for our health care dollars.

William Kramer, Executive Director for National Health Policy, PBGH

We believe last week’s announcement will encourage more providers to participate in this program.  From the perspective of consumers, we applaud the strong emphasis on patient-centered criteria that should pave the road to better care.  And especially as advocates for our oldest, sickest and highest risk patients, we applaud this

effort to incentivize better primary care, increased coordination, and shared accountability across providers. From the perspective of purchasers, we believe that CMS has crafted a foundation to hold providers accountable for quality performance and cost savings, and created a path to move providers away from today’s perverse fee-for-service system.

We are very pleased that this final rule will require ACOs to use beneficiary experience of care and outcome measures to evaluate performance. We believe CMS landed in a better place with respect to the quality measures ACOs must report on.  While we appreciated the comprehensiveness of the original list of 65 measures, there were a number of measures that added minimal value.  The final list of 33 measures is a stronger set that focuses on highest impact measures and, very importantly, includes measures of patient experience, functional status and clinical outcomes, care coordination and safety.  We would, however, have liked pay-for-performance to occur sooner in the program, especially for measures that are already in use.  Finally, we are very pleased that this final rule continues to ensure full transparency, notification and choice for beneficiaries. These provisions are all essential to engaging consumers in a positive way and realizing the promise of successful ACOs.

Nobody got everything they wanted in the final rule and we, too, have concerns.  We are disappointed that the upfront anti-trust review process is no longer mandatory, but glad there is strong acknowledgement that there must be close monitoring for any signs of cost-increasing market concentration.  We are glad to see that the final rule requires CMS to share ACO applications and new types of data that will strengthen the ability of the Federal Trade Commission and Department of Justice to assess and monitor the market impacts.

It is also unfortunate that the provisions requiring beneficiary participation on ACO boards have been tempered, rather than expanded to include representation from a diverse range of community stakeholders, including purchasers, labor and community-based groups. It is now incumbent on CMS to closely monitor ACOs to ensure that they reflect the community interests they are intended to serve, and that consumers, beneficiaries and other key stakeholders are engaged in the design, governance and evaluation of their performance. Consumers and purchasers hope and expect that these provisions will be strengthened down the road if needed.

Every leader from every sector has a list like this – things they like, and things they don’t like, in the final rule. But the time for tallying who won and who lost, and by how much, is over. Now it’s time for all parties to come together to create successful ACOs that deliver care that is patient-centered, that improves quality and care coordination, and that lowers costs. The stakes are too high to let anything stand in our way, or to let opponents of reform exploit any remaining differences.

We said before this rule was released that it’s time for a new dynamic where we come together to implement the reforms the nation so urgently needs. ACOs are one of many promising models and initiatives that will be tested by the CMS Innovation Center over time. It is well past time to leave our broken, dysfunctional health care system behind and give the Accountable Care Organization model the test it deserves.

The final rule gives us a chance to do that. That’s all we could ask. CMS has done its part. Now it’s time for the rest of us to do ours. If we do, patients, their families and family caregivers, our economy and our nation will benefit.

Debra L. Ness is President of the National Partnership for Women & Families. William Kramer is the Executive Director for National Health Policy at the Pacific Business Group on Health. Together, they co-chair the Consumer-Purchaser Disclosure Project, a group of leading employer, consumer, and labor organizations working toward a common goal: to ensure that all Americans have access to publicly reported health care performance information.

Cross-posted from the Health Affairs Blog.

Realizing the Full Potential of Health Reform

Published on October 11, 2011 in Debra Ness, Health Care, Quality and Reform. 0 Comments

Debra Ness, President

When it passed, we recognized the Affordable Care Act (ACA) as the greatest advance for women’s health in a generation.

This new law is already beginning to eliminate the punitive and predatory insurance practices that have penalized women and families for decades, and instead bringing us closer to the day when essential women’s services are fully covered, prevention is a priority, and care is coordinated so family caregivers don’t struggle to shoulder impossible loads. The benefits to women – and their families – are myriad. Health reform means insurers cannot charge women more because of our gender, or deny or cap our coverage when we get sick. It means coverage for breast and cervical cancer screenings and family planning services. It ends the days when young adult children were kicked off their parents’ insurance policies.

So why is a law that’s brought so much progress, and even more promise, in such great peril? Because too many lawmakers are putting politics ahead of the best interests of their constituents, who urgently need reliable, affordable, comprehensive and well-coordinated health care. They are more interested in throwing up roadblocks and scoring political points than focusing on what the country needs.

It’s time to take a step back and reconsider what’s best for women and families, for our economy and for the country. We need to realize the promise of health reform by allowing implementation to proceed. And we need to adopt the family friendly policies that will allow workers to access the health care services they need, while holding onto their jobs.

I read with interest a recent study by a Robert Wood Johnson Foundation scholar which found that more adults postpone or go without medical care for nonfinancial reasons than for financial reasons. The researcher, Jeffrey T. Kullgren, notes that: “Many patients also have nonfinancial reasons they can’t get the health care they need when they need it. They may live a great distance from the doctor, and traveling is a challenge. They may work jobs that make it hard to go to a doctor’s office during a normal business day, where leaving work would mean they wouldn’t get paid or might risk losing their job.”

That’s not a huge surprise when you consider that nearly 44 million workers in the United States don’t have paid sick days. A mere 11 percent have access to paid family leave through their employers, and fewer than 40 percent have access to paid medical leave through employer-provided short-term disability insurance. When workers are without these basic protections, they are forced to choose between their health and their financial security when illness strikes – and in this job market, it’s no surprise many choose to forgo treatment and preventive care rather than risking their jobs or their paychecks.

So instead of continuing the posturing and politicking and efforts to repeal health reform, let’s get to the business at hand – work together to implement the Affordable Care Act, and adopt paid sick days and paid family and medical leave. Then, we’ll be on track for healthier workers, healthier families, and a healthier country.

On the Right Track: Institute of Medicine’s Essential Benefits Report

Published on October 7, 2011 in Debra Ness, Health Care, Reform and Reproductive Health. 0 Comments

Debra Ness, President

America’s women and families want and need confidence that when they buy health insurance, it will cover comprehensive benefits that meet their needs. Thanks to health reform, we may soon get that.

The new law charged the U.S. Department of Health and Human Services with determining exactly what services should be considered “essential benefits” that must be covered by health insurance.  To help Secretary Kathleen Sebelius shape this package, the Institute of Medicine (IOM) created a committee to recommend a process and methodology for defining the essential benefit package – because how that package is designed, and what is included and excluded, will help determine whether reform delivers on its promise.

The committee’s report, released today, is hugely promising. It proposes a process for determining essential benefits that is a balanced approach that prioritizes public involvement.  Women and families will have a say, helping to ensure that the final package reflects their needs and values.

A primary aim of the Affordable Care Act (ACA) is to ensure that women and families can access better, more reliable coverage for a range of health care needs – from prevention to women’s health services to coverage of chronic conditions and more. The IOM committee’s report aims to do that and to strike a balance between comprehensiveness of coverage and cost.

We are pleased that the committee recommended that the essential benefits package not be used simply as a cost containment tool. Rather, members recognized that we must look at the broader picture of how to address skyrocketing health care costs. We urge the Secretary to not only consider the short term costs of any given benefit, but the long-term value of a package that pays for the items and service that women and families need to get and stay healthy.

Women will be better off if the Secretary establishes an essential benefits package that includes reproductive health services, care coordination and palliative care.  We are especially hopeful that the package will cover maternity care, well-woman and well-child visits, cancer screenings and the full range of reproductive health services and supplies. We want to see care coordination and primary care fully covered.  We hope it will to cover language access services, which have the potential to drive down costs associated with the unnecessary care that is common for limited English proficiency patients.

Importantly, the committee today also recognized that our definition of what constitutes an essential benefit may change in the future. We applaud the creation of the National Benefits Advisory Council, an independent, non-partisan advisory group comprising a variety of stakeholders – including consumers – to update the essential benefit package over time.

The work the IOM committee has done is good for women and for all consumers, but now we need to encourage the Administration to adopt its recommendations. Only then can we ensure that those who need help the most can access the health care they need – which is, after all, what reform is all about.

To learn more, go here and here.