Necessary health care and basic needs: Health insurance plans and essential benefits

Andrew Ward, Pamela Jo Johnson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

According to HealthCare.gov, by improving access to quality health for all Americans, the Affordable Care Act (ACA) will reduce disparities in health insurance coverage. One way this will happen under the provisions of the ACA is by creating a new health insurance marketplace (a health insurance exchange) by 2014 in which "all people will have a choice for quality, affordable health insurance even if a job loss, job switch, move or illness occurs". This does not mean that everyone will have whatever insurance coverage he or she wants. The provisions of the ACA require that each of the four benefit categories of plans (known as bronze, silver, gold and platinum) provides no less than the benefits available in an "essential health benefits package". However, without a clear understanding of what criteria must be satisfied for health care to be essential, the ACA's requirement is much too vague and open to multiple, potentially conflicting interpretations. Indeed, without such understanding, in the rush to provide health insurance coverage to as many people as is economically feasible, we may replace one kind of disparity (lack of health insurance) with another kind of disparity (lack of adequate health insurance). Thus, this paper explores the concept of "essential benefits", arguing that the "essential health benefits package" in the ACA should be one that optimally satisfies the basic needs of the people covered.

Original languageEnglish (US)
Pages (from-to)355-371
Number of pages17
JournalHealth Care Analysis
Volume21
Issue number4
DOIs
StatePublished - Dec 2013

Keywords

  • Basic needs
  • Capabilities
  • Discourse ethics
  • Essential health benefits
  • Habermas
  • Health insurance
  • Medical necessity
  • Opportunities

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