According to an article recently published in Health Affairs, if the Affordable Care Act (ACA) had been in place in 2001-2008, people in the individual insurance market would have saved about $280 per year on out-of-pocket costs. These savings would have been even more significant for people aged 55-64, as this age group racks up higher medical bills, but is still ineligible for Medicare. The root of the savings under the ACA is in the creation of the new health insurance exchanges, which make coverage more accessible for consumers in the individual market. Plans distributed through exchanges must cover essential health benefits, which include benefits such as prescription drugs and certain preventive services without copayments. The essential health benefit requirement in the exchanges will make the individual policies more generous and will create significant annual out-of-pocket savings for consumers. In addition, the study reports that the ACA reduces the risk of incurring high out-of-pocket costs. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many.

Alan Weil, Executive Director of the National Academy for State Health Policy (NASHP) recently authored "The Value of Federalism in Defining Essential Health Benefits" in the New England Journal of Medicine (NEJM). The perspective piece addresses Human Services Secretary Kathleen Sebelius's December 2011 announcement, stating that there would not be one single national definition of Essential Health Benefits. Rather, each state will have 10 options to choose from in defining the EHBs, 7 of which are tied to existing coverage in that state's small-group, state-employee, and health maintenance organization markets. Weil then relates Sebelius's announcement to the principles of federalism. He argues that there are three potential benefits associated with permitting states to make these decisions with respect to the EHBs. These three advantages relate to learning what works, tailoring policies to local conditions, and reflecting citizens’ values.

The Institute of Medicine (IOM) of the National Academy of Sciences (NAS) has released their highly-anticipated essential benefits report. The report, "Essential Benefits: Balancing Coverage and Cost," recommends that the U.S. Department of Health and Human Services (HHS) consider cost of services as factor when determining the specific benefits qualified health plans (QHPs) must include. The Affordable Care Act (ACA) requires the Secretary of HHS to come up with a minimum essential benefits package that all health plans must offer by January 1, 2014, and HHS tasked the IOM with making recommendations on how HHS should determine which benefits to include. For more information on essential benefits, click here.