What Jon Stewart Taught Me About Essential Health Benefits
As a twenty-something, I get my health policy news from a variety of sources: Twitter, daily email digests, Kaiser Health News, blogs, and even the hard-copy New York Times on Sunday morning. But after my Twitter feed lit up with praise for a recent Jon Stewart interview—“crazy good questions,” “surprisingly substantive,” and “wonktastic!”—The Daily Show now occupies a spot on that list.
Jon Stewart – Who knew he was such a health policy wonk? – interviewed Health and Human Services (HHS) Secretary Kathleen Sebelius on recent developments related to the Affordable Care Act. Part one is below, and the second part is available here.
A few things I learned from the rather informative 16-minute interview:
1. The theory behind “essential health benefits” is that it partially addresses the issue of underinsurance. Underinsured is a term used to describe people who have insurance but still spend a large proportion of their income on care that their plan doesn’t cover. About 675,000 Coloradans are underinsured, according to the 2011 Colorado Health Access Survey. In the interview, Secretary Sebelius mentioned that 60% of the plans sold to individuals don’t cover maternity care, and one of three plans don’t cover substance abuse services. By making sure that all health plans cover basic services such as maternity care, prescription drugs and hospitalizations, fewer Coloradans will be stuck with overwhelming medical bills if they get sick.
2. Secretary Sebelius said that “the way the law was written in the first place is that states get to take the lead…around a set of rules.” Although the ACA gets a reputation for being 2,700 pages of federal top-down mandates, it’s really more of a partnership with the states. Essentially the feds are laying the foundation for the house—but the states are responsible for building the rest of it and deciding what furniture to put in it. The Colorado Health Benefit Exchange is one example of this, and the definition of essential health benefits are another. The recent HHS bulletin allows states to choose from a number of different plans as a “benchmark.” Colorado can choose one of the most popular small employer plans, for example, when it decides what exactly counts as an essential health benefit. What counts—and who decides—are important discussions that will play out in Colorado in 2012.
3. Upon reading the words “actuarial value,” your eyes will probably roll just like Jon Stewart’s. However, Secretary Sebelius’ definition was the simplest I’ve heard: it’s basically a tool to help you choose how much deductible you’re willing to pay. Under the ACA, consumers will choose between health insurance plans that pay a smaller chunk of costs (labeled as “bronze” or “silver” plans) and plans that pay a larger proportion (“gold” or “platinum” plans.)
The health reform law is complicated, and poll after poll suggests that most Americans don’t entirely understand how it will affect them in real life. If the information is reliable and accurate, it doesn’t matter where it comes from—even if it’s Jon Stewart embracing his inner policy wonk.