Essential Health Benefits: Balancing Affordability and Adequacy John Santa MD MPH Director, Health Ratings Center Consumer Reports February 3, 2012

12. Consumer Reports employee R A E R T

Systems are perfectly designed to get the results they achieve.

Key Decisions Already Made Should health insurance be market based? If market based should we enable/encourage competition? Should that competition include price/cost?

IOM Essential Health Benefits Principles for Proceeding Economics Ethics Evidence based practice Population health

Functional Competition Level playing field –What is promised---benefits –What it costs---premium, cost share –What is delivered---access, quality

Benefits Adequacy –Precise, understandable benefit language –Clear cut limits and exclusions –Understandable key definitions –Metric that expresses benefit value Affordability –Precise, understandable price language –Metric that expresses impact of cost sharing

When youre through learning, youre through. John Wooden Former UCLA basketball coach

John Santa MD MPH Consumer Reports Health Director, Health Ratings Center