IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v118y2014i3p285-291.html
   My bibliography  Save this article

Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act

Author

Listed:
  • Haeder, Simon F.

Abstract

The Essential Health Benefits provisions under the Affordable Care Act require that eligible plans provide coverage for certain broadly defined service categories, limit consumer cost-sharing, and meet certain actuarial value requirements. Although the Department of Health and Human Services (HHS) was tasked with the regulatory development of these EHB under the ACA, the department quickly devolved this task to the states. Not surprisingly, states fully exploited the leeway provided by HHS, and state decision processes and outcomes differed widely. However, none of the states took advantage of the opportunity to restructure fundamentally their health insurance markets, and only a very limited number of states actually included sophisticated policy expertise in their decisionmaking processes. As a result, and despite a major expansion of coverage, the status quo ex ante in state insurance markets was largely perpetuated. Decisionmaking for the 2016 revisions should be transparent, included a wide variety of stakeholders and policy experts, and focus on balancing adequacy and affordability. However, the 2016 revisions provide an opportunity to address these previous shortcomings.

Suggested Citation

  • Haeder, Simon F., 2014. "Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act," Health Policy, Elsevier, vol. 118(3), pages 285-291.
  • Handle: RePEc:eee:hepoli:v:118:y:2014:i:3:p:285-291
    DOI: 10.1016/j.healthpol.2014.09.014
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851014002607
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.healthpol.2014.09.014?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Calltorp, Johan, 1999. "Priority setting in health policy in Sweden and a comparison with Norway," Health Policy, Elsevier, vol. 50(1-2), pages 1-22, December.
    2. Reinhard Busse & Tom Stargardt & Jonas Schreyögg, 2005. "Determining the “Health Benefit Basket” of the Statutory Health Insurance scheme in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 30-36, November.
    3. Busse, Reinhard, 1999. "Priority-setting and rationing in German health care," Health Policy, Elsevier, vol. 50(1-2), pages 71-90, December.
    4. Gruber, Jonathan, 1994. "State-mandated benefits and employer-provided health insurance," Journal of Public Economics, Elsevier, vol. 55(3), pages 433-464, November.
    5. Ham, Chris, 1997. "Priority setting in health care: learning from international experience," Health Policy, Elsevier, vol. 42(1), pages 49-66, October.
    6. Summers, Lawrence H, 1989. "Some Simple Economics of Mandated Benefits," American Economic Review, American Economic Association, vol. 79(2), pages 177-183, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Nour Kattih & Fady Mansour & Franklin G. Mixon, 2021. "Keeping what you like: grandfathering and health insurance coverage take-up rates under the ACA," Journal of Economics and Finance, Springer;Academy of Economics and Finance, vol. 45(1), pages 188-199, January.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Christine Jolls, 2007. "Employment Law and the Labor Market," NBER Working Papers 13230, National Bureau of Economic Research, Inc.
    2. Schmidt, Lucie, 2007. "Effects of infertility insurance mandates on fertility," Journal of Health Economics, Elsevier, vol. 26(3), pages 431-446, May.
    3. Lennon, Conor, 2021. "Are the costs of employer-sponsored health insurance passed on to workers at the individual level?," Economics & Human Biology, Elsevier, vol. 41(C).
    4. Joanna N. Lahey, 2012. "The efficiency of a group‐specific mandated benefit revisited: The effect of infertility mandates," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 31(1), pages 63-92, December.
    5. Yaa Akosa Antwi & Johanna Catherine Maclean, 2017. "State Health Insurance Mandates and Labor Market Outcomes: New Evidence on Old Questions," NBER Working Papers 23203, National Bureau of Economic Research, Inc.
    6. Andersen, Martin, 2015. "Heterogeneity and the effect of mental health parity mandates on the labor market," Journal of Health Economics, Elsevier, vol. 43(C), pages 74-84.
    7. Maclean, J. Catherine & Webber, Douglas A., 2019. "Government Regulation and Lifecycle Wages: Evidence from Continuing Coverage Mandates," IZA Discussion Papers 12464, Institute of Labor Economics (IZA).
    8. Dwight Lee & Ronald Warren, 1999. "Mandated health insurance and the low-wage labor market," Journal of Labor Research, Springer, vol. 20(4), pages 505-515, December.
    9. Ottersen, Trygve & Førde, Reidun & Kakad, Meetali & Kjellevold, Alice & Melberg, Hans Olav & Moen, Atle & Ringard, Ånen & Norheim, Ole Frithjof, 2016. "A new proposal for priority setting in Norway: Open and fair," Health Policy, Elsevier, vol. 120(3), pages 246-251.
    10. Son, Jinyeong, 2022. "Do mandated health insurance benefits for diabetes save lives?," Journal of Public Economics, Elsevier, vol. 216(C).
    11. Jinqi Ye, 2017. "The Effects of State and Federal Mental Health Parity Laws on Working Time," Center for Policy Research Working Papers 200, Center for Policy Research, Maxwell School, Syracuse University.
    12. Li, Xiaoxue & Ye, Jinqi, 2017. "The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans," Journal of Health Economics, Elsevier, vol. 55(C), pages 45-60.
    13. Bailey, James, 2013. "Who pays for obesity? Evidence from health insurance benefit mandates," Economics Letters, Elsevier, vol. 121(2), pages 287-289.
    14. Maclean, Johanna Catherine & Webber, Douglas, 2022. "Government regulation and wages: Evidence from continuing coverage mandates," Labour Economics, Elsevier, vol. 78(C).
    15. Chia Jung Chang, 2021. "Is the Road to Unemployment Paved with Good Intentions? Labor Market Outcomes of Young Women," Journal of Labor Research, Springer, vol. 42(2), pages 244-302, June.
    16. Douglas C. Bice & William H. Hoyt, 1997. "The Impact of Mandates and Tax Limits on Voluntary Contributions to Local Public Services: An Application to Fire Protection Services," Public Economics 9704002, University Library of Munich, Germany.
    17. Jonathan Gruber, 2008. "Covering the Uninsured in the U.S," NBER Working Papers 13758, National Bureau of Economic Research, Inc.
    18. Bossavie, Laurent & Cho, Yoonyoung & Heath, Rachel, 2023. "The effects of international scrutiny on manufacturing workers: Evidence from the Rana Plaza collapse in Bangladesh," Journal of Development Economics, Elsevier, vol. 163(C).
    19. Benjamin Bennett & Isil Erel & Léa H. Stern & Zexi Wang, 2020. "Paid Leave Pays Off: The Effects of Paid Family Leave on Firm Performance," NBER Working Papers 27788, National Bureau of Economic Research, Inc.
    20. Daron Acemoglu & Joshua D. Angrist, 2001. "Consequences of Employment Protection? The Case of the Americans with Disabilities Act," Journal of Political Economy, University of Chicago Press, vol. 109(5), pages 915-957, October.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:118:y:2014:i:3:p:285-291. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.