ACS Cancer Action Network Essential Health Benefits Forum
February 28, 2011
Thank you very much. I am delighted to be here.
I want to thank the American Cancer Society Cancer Action Network for their leadership and commitment to good health for every American.
In recent years, we have made great strides in our fight against cancer. You have been there every step of the way. And as we have implemented the Affordable Care Act, my department has looked to organizations like yours to make sure we’re serving the American people as effectively as possible. Your ongoing engagement is crucial.
That’s especially true when it comes to the issue we’re focusing on today: Essential Health Benefits. When we released the initial Bulletin in December, we saw it as the beginning of a dialogue. With your support, that’s exactly what’s taking place here. And I want to thank you for continuing this important conversation.
But before you get into the details, I want to begin today by talking about how these proposed policies fit into the broader context of health reform. And more specifically, I want to explore what the law means for our battle against devastating diseases like cancer.
In the past, our insurance market really had three fundamental problems.
First, we had 50 million people locked out or priced out of the market. Insurers could pick and choose who they gave coverage to. And premiums were skyrocketing. People with cancer often found themselves without access to any coverage at all.
The second problem was that your insurance could be taken away when you needed it most. Insurers could put a lifetime cap on the amount of care they would pay for. Cancer patients sometimes saw their coverage max out right in the middle of a course of chemotherapy. And more often than not, these kinds of limits were buried in the fine print, so patients wouldn’t learn about them until it was too late.
Even worse, insurers could cancel your coverage after you got sick just by finding an accidental mistake in your paperwork. As you know, some insurance companies even used computer programs designed to specifically search the records of people with breast cancer looking for these errors.
The third hurdle was that even if you did have insurance, it might not cover the care you need. This was particularly problematic when it came to preventive care. We know that the best way to stop cancer is to prevent it or catch it early. But a lot of times, insurance companies didn’t cover preventive care like tobacco cessation counseling, mammograms, and colon cancer screenings. Or if they did cover it, they imposed expensive co-pays and deductibles that put it out of reach for many families.
And it wasn’t just preventive care. Some plans had so many holes that they provided almost no security if you got really sick. For example, 62% of individual market plans do not cover maternity coverage, 18% do not cover mental health services, and 9% do not cover prescription drugs today.
So we had a broken system: Too many patients couldn’t get coverage. Many of those who did have insurance lost it when they needed it most. And others had insurance that didn’t cover the care they really needed. In the fight against cancer and other serious diseases, all of these obstacles had put millions of Americans at a major disadvantage.
But today, the Affordable Care Act has begun to remove those obstacles.
First, the law is expanding coverage to the uninsured. Through Pre-Existing Condition Insurance Plans, tens of thousands of Americans who had been locked out of the market are now getting the health insurance they need. It is also now illegal to deny coverage to a child because of a pre-existing condition. And in 2014, that protection will extend to everyone.
Second, under the Patient’s Bill of Rights, insurance plans are now prohibited from imposing lifetime dollar limits on essential health benefits. And your insurance also cannot be taken away right when you need it most, just because of an unintentional error on your application.
Third, we’re making sure that your insurance covers the care you need. Last year, 54 million Americans with private health insurance gained access to free recommended preventive care thanks to the health care law. Another 32 million seniors and people with disabilities on Medicare also took advantage of preventive services with zero cost sharing.
So with these protections and new benefits, we’ve begun to remove the obstacles to affordable, comprehensive coverage for millions of Americans.
But we have another important step to take. And that is to establish Essential Health Benefits -- the basic standard of coverage that plans for Americans in the individual and small group markets will have to offer starting in 2014.
As you know, the health care law outlines 10 areas of basic coverage, including preventive services, prescription drugs, pediatric care and hospital services, which are now offered in good employer-based plans around the country. In December, our department put out the initial bulletin outlining our intended approach.
Our goal is to ensure that all plans offered in the marketplace are affordable and comprehensive, without the gaps in coverage that too many consumers have faced. But we also know that health care is different in every state, and that the coverage that works in Florida might not work in Nebraska.
Under the approach we have outlined, states will have the flexibility to pick their own standard from among the most typical, popular and proven employer plans in their own state.
I know some people have expressed concern that by giving states flexibility to choose the benchmark plan, patients with serious diseases like cancer may not get the protections and care they deserve. But I am confident that the right safeguards are in place.
First, we’ve analyzed the benefits covered by employers today. And what we found is that the suggested standard plan options are similar in every state. The approach we’ve outlined provides states the flexibility to tailor benefits to their circumstances, while still assuring all Americans access to essential health benefits.
Second, annual and lifetime dollar limits on essential health benefits are already illegal. That’s the rule I mentioned earlier under the Patient’s Bill of Rights.
And third, while our policy will guarantee that each state must ensure coverage for the 10 categories laid out by the law, it will also protect against discrimination. In other words, no plan offering essential health benefits can provide coverage that leaves one group protected and another out in the cold.
But there’s another safeguard and that’s your watchful eyes and continuous feedback. We look forward to your comments. And as we work toward a Notice of Proposed Rule Making and a final rule, we will continue to solicit public comment. Once the process moves to the states, you have a vital role there as well – to make sure state officials choose the benchmark plan that’s right for consumers. And before 2016, we will evaluate and adjust the guidelines if necessary.
Our ultimate goal is to make sure the insurance market works better for consumers. And together with the other protections under the law, this approach means that a new kind of health insurance marketplace is emerging.
It means that no matter where they live, Americans will have access to the basic care they need to stay healthy. It means that Americans buying coverage will know they’re getting a health plan that will be there when they need it. And it means they won’t have to worry about learning of a hidden loophole in their plan when they get sick.
Now, we also recognize that the fight against cancer and other serious diseases is about even more than having quality health insurance.
That’s why this administration has also made historic investments in biomedical research – including funding efforts like the Cancer Genome Atlas and the National Lung Screening Trial.
It’s why we’ve invested billions to combat chronic disease and promote healthy lifestyles at the community level, from the First Lady’s Let’s Move campaign to end childhood obesity, to historic new efforts to regain the momentum in our fight against tobacco use.
President Obama has been talking recently about this Administration’s all-of-the-above approach to energy. Right now, we’re also taking an all-of-the-above approach to improving America’s health.
And with your guidance and support, we can continue to build on the progress we have already made to give every American new hope for a brighter, healthier future.