KHN: Kaiser Health News

The Department of Health and Human Services today released a document intended to preview the kinds of benefits most health plans must offer starting in 2014. But one consumer advocate said it does not provide nearly enough information to be helpful.

The federal government in December gave states significant leeway to decide what “essential benefits” must be included in coverage sold to individuals or small businesses under the 2010 health law. The law mandates coverage within 10 benefit categories; it’s up to each state to decide specifics, such as how many doctors’ visits or what drug services the plans will be required to offer. States can use several options to base those benefit requirements, including what some existing health plans in the state offer.

Today, HHS released a list of some insurance products in each state that could serve as models, but while the document included names of plans, it did not indicate what benefits are covered by those plans or what benefits it would like to see in future plans.

It’s a problem not to have the details about what is in the plans, said Stephen Finan, senior director of policy at the American Cancer Society-Cancer Action Network. While some benefit specifics can be found online, Finan said that without the whole package, “we remain completely in the dark.”

In December, the Cancer Society signed onto a letter with other consumer groups asking HHS to identify which health plans states could choose as benchmarks. Finan says that today’s list is helpful, but that it will be difficult to get detailed benefit information.

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This story comes from our partner ‘s Shots blog.

Photo by Images Money via Flickr

There’s little doubt that the U.S. wastes a lot of money on unnecessary health care. But pinning down the worst offenders isn’t easy, as a fresh analysis of the scientific literature finds.

Published research on overuse is in pretty short supply, so rooting out waste by looking at the existing studies can be a little like limiting your late-night search for lost car keys to the spots right under streetlights.

Still, you’ve got start somewhere.

And a group of researchers combed the literature, zeroing in on 172 papers (out of more than 114,000 relevant ones published between 1978 and 2009) to see where the evidence for overuse was strongest.

What did they find?

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Leaders from some of the nation’s top consumer and seniors advocacy groups today urged President Barack Obama not to weaken a key consumer provision of his signature health care overhaul law.

The provision requires health insurers and employers to use standardized, easy-to-understand information documents to describe health plan benefits and costs.   These forms would explain how much each plan pays on average for three common medical conditions and include a glossary of insurance terms.

“The summary of benefits and coverage [document] is a vital first step in making consumers better informed and able to make the proper decisions for themselves,” said Stephen Finan, senior director for policy for the American Cancer Society Cancer Action Network, one of the signers of the letter to the president.  In some states, information about providers and other policy details are not disclosed until after a consumer applies for coverage, he said.  Shoppers today, he explained, can get better information about buying a new washing machine than they can about a health insurance policy.

“You pay first and learn later,” he said.

The letter was signed by the chief executive officers of the American Cancer Society, American Heart Association, American Diabetes Association, Consumers Union and AARP, which has 37 million members age 50 and older.

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Adam Rapp of Fall Creek Township, Ill., will have one of the best seats in the House as President Barack Obama addresses a joint session of Congress Tuesday night.

President Obama's 2011 State of the Union address to Congress (Chuck Kennedy/White House via Wikimedia Commons)

In a custom dating back to the Reagan administration, the first lady’s guest list for the annual State of the Union address combines both personal and political considerations.  Guests are often selected as exemplars of administration policies or topics the president will discuss during his speech.

A release from the White House describes Rapp as someone who benefited from the 2010 health law’s provision mandating that adult children remain eligible for coverage under their parents’ health insurance plans until their 26th birthdays.   Rapp, diagnosed with cancer on his 23rd birthday, was able to remain on his parents’ policy during his treatment.

Rapp told the Quincy Herald-Whig that without the change in the law, ”I definitely wouldn’t have gotten the treatment I needed. There’s no other way to put it.”

Government data show 2.5 million young adults have taken advantage of this provision.

The Patient-Centered Outcomes Research Institute (PCORI) — created by the health law to help determine the most effective medical treatments — released its draft priorities and research agenda on Monday, but it did not single out any specific diseases, treatments or procedures to study.

Instead, the nongovernmental institute that will oversee billions in research funding  “specifies a set of questions and topics” in five broad categories. Those are: comparing various medical options, improving the health care system, improving communication of research findings to patients and clinicians, addressing health disparities and finding ways to improve research methods.

Although comparative effectiveness research has been around for a long time, the new panel has drawn opposition from some Republican lawmakers who fear it will be used to ration care. By not naming specifics, PCORI sidesteps controversy that might arise from selecting certain diseases or treatments, but not others.  Rather than PCORI deciding up front which diseases or treatments deserve top priority, researchers will submit questions they want to answer in their funding applications.  Still, PCORI  will ultimately need to select which research projects to finance.

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