IOM’s recommendations – a step away from affordability?

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The first step in defining the essential benefits package – the coverage coin of the health care realm for decades ahead (if the new health care law stays in place) – has now been taken. The Institute of Medicine has issued sweeping recommendations on women’s health, particularly preventative and reproductive health. HHS Secretary Sebelius has indicated that she will likely accept the recommendations. Great controversy will ensue and politics will run rampant. Is there an election coming?

Prevention is clearly the key to better control of future health care costs. Women’s health is vitally important. Congress was quite specific on this in the reform law (Patient Protection and Affordable Care Act). The die was cast in such a way that the nominally nonpartisan academics at IOM could not help but take note in crafting its recommendations to order. Secretary Sebelius has the final say on inclusion of this and other IOM recommendations in the essential benefits package that will define private and public coverage.

I can’t disagree with the priority – like everyone else, I would spend anything I could to protect the loved ones in my life. But, just as most of us don’t drive around in bullet-proof limousines with protection from natural and man-made plagues, there are limits to the amount of protection we can afford for our families. This frontier – between prevention, protection and affordability – will define health care in America for the foreseeable future.

NRF will make this issue – the affordability of the essential benefits package – our chief health care priority ahead. Finding the balance between affordability and comprehensiveness – and placing the bigger emphasis on affordability – is crucial. To do otherwise would be to say, as Marie Antoinette once famously may have, “let them eat cake.” Super-sized coverage that no one can afford is not coverage at all….

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