Health Exchange Benefits Should Be More Generous, Docs Say

Physicians who support a single-payer health system are urging the federal government to reject the Institute of Medicine’s recommendations for designing the benefits package to be offered in the state-based health insurance exchanges.

Physicians for a National Health Plan (PNHP) is leading the effort to cast off recommendations issued by the Institute of Medicine (IOM) in October, charging the panel was unduly influenced by the insurance industry. The IOM panel called on the Department of Health and Human Services to base the essential benefits package on the benefits typically offered by small employers. It also urged the agency to consider cost when designing the package of required benefits.

In a Dec. 1 letter to HHS Secretary Kathleen Sebelius, more than 2,400 physicians, nurses, and health advocates criticized the IOM recommendations, saying that they would provide "skimpy" coverage.

"The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness," according to the PNHP letter. "Yet this strategy will not lower costs. Delaying care often creates even higher costs. Steadily rising copayments and deductibles over the past two decades have failed to stem skyrocketing medical inflation."

"The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness," according to the Physicians for a National Health Plan letter.

Dr. Steffie Woolhandler, a cofounder of PNHP and professor of public health at the City University of New York, said that the recommendations from the IOM panel are not what was envisioned by supporters of the Affordable Care Act. Instead, supporters had expected that the essential benefits package would be based on the more generous benefits offered by large employers.

The letter also attacked the IOM panel for including members who have "amassed personal wealth through their involvement with health insurers and other for-profit health care firms."

Dr. Woolhandler, who served as an IOM fellow in 1990-1991, cited the inclusion of Sam Ho, executive vice president of UnitedHealthcare, and Leonard Schaeffer, former chairman and CEO of WellPoint.

Allowing individuals with financial ties to the insurance industry to serve on the IOM panel is contrary to the IOM’s own recommendations, issued in 2009, on minimizing conflicts of interest on panels that issue clinical practice guidelines, Dr. Woolhandler added.

Although Mr. Ho and Mr. Schaeffer have knowledge about the insurance business, there are many qualified experts without conflicts who could have been selected for the panel, she said. "A lot of people know about health insurance benefits," she said.

The IOM stood by the panel and its recommendations. "The IOM report speaks for itself and details the solid rationale for each of its recommendations for achieving a balance between coverage and cost," said Christine Stencel, an IOM spokeswoman.

The 18-member panel was chaired by Dr. John R. Ball, former executive vice president of the American Society for Clinical Pathology. The panel also included Dr. Alan Nelson, a health policy expert and retired internist/endocrinologist; Christopher F. Koller, health insurance commissioner for Rhode Island; and several policy experts.

Physicians who support a single-payer health system are urging the federal government to reject the Institute of Medicine’s recommendations for designing the benefits package to be offered in the state-based health insurance exchanges.

Physicians for a National Health Plan (PNHP) is leading the effort to cast off recommendations issued by the Institute of Medicine (IOM) in October, charging the panel was unduly influenced by the insurance industry. The IOM panel called on the Department of Health and Human Services to base the essential benefits package on the benefits typically offered by small employers. It also urged the agency to consider cost when designing the package of required benefits.

In a Dec. 1 letter to HHS Secretary Kathleen Sebelius, more than 2,400 physicians, nurses, and health advocates criticized the IOM recommendations, saying that they would provide "skimpy" coverage.

"The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness," according to the PNHP letter. "Yet this strategy will not lower costs. Delaying care often creates even higher costs. Steadily rising copayments and deductibles over the past two decades have failed to stem skyrocketing medical inflation."

"The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness," according to the Physicians for a National Health Plan letter.

Dr. Steffie Woolhandler, a cofounder of PNHP and professor of public health at the City University of New York, said that the recommendations from the IOM panel are not what was envisioned by supporters of the Affordable Care Act. Instead, supporters had expected that the essential benefits package would be based on the more generous benefits offered by large employers.

The letter also attacked the IOM panel for including members who have "amassed personal wealth through their involvement with health insurers and other for-profit health care firms."

Dr. Woolhandler, who served as an IOM fellow in 1990-1991, cited the inclusion of Sam Ho, executive vice president of UnitedHealthcare, and Leonard Schaeffer, former chairman and CEO of WellPoint.

Allowing individuals with financial ties to the insurance industry to serve on the IOM panel is contrary to the IOM’s own recommendations, issued in 2009, on minimizing conflicts of interest on panels that issue clinical practice guidelines, Dr. Woolhandler added.

Although Mr. Ho and Mr. Schaeffer have knowledge about the insurance business, there are many qualified experts without conflicts who could have been selected for the panel, she said. "A lot of people know about health insurance benefits," she said.

The IOM stood by the panel and its recommendations. "The IOM report speaks for itself and details the solid rationale for each of its recommendations for achieving a balance between coverage and cost," said Christine Stencel, an IOM spokeswoman.

The 18-member panel was chaired by Dr. John R. Ball, former executive vice president of the American Society for Clinical Pathology. The panel also included Dr. Alan Nelson, a health policy expert and retired internist/endocrinologist; Christopher F. Koller, health insurance commissioner for Rhode Island; and several policy experts.

Physicians who support a single-payer health system are urging the federal government to reject the Institute of Medicine’s recommendations for designing the benefits package to be offered in the state-based health insurance exchanges.

Physicians for a National Health Plan (PNHP) is leading the effort to cast off recommendations issued by the Institute of Medicine (IOM) in October, charging the panel was unduly influenced by the insurance industry. The IOM panel called on the Department of Health and Human Services to base the essential benefits package on the benefits typically offered by small employers. It also urged the agency to consider cost when designing the package of required benefits.

In a Dec. 1 letter to HHS Secretary Kathleen Sebelius, more than 2,400 physicians, nurses, and health advocates criticized the IOM recommendations, saying that they would provide "skimpy" coverage.

"The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness," according to the PNHP letter. "Yet this strategy will not lower costs. Delaying care often creates even higher costs. Steadily rising copayments and deductibles over the past two decades have failed to stem skyrocketing medical inflation."

"The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness," according to the Physicians for a National Health Plan letter.

Dr. Steffie Woolhandler, a cofounder of PNHP and professor of public health at the City University of New York, said that the recommendations from the IOM panel are not what was envisioned by supporters of the Affordable Care Act. Instead, supporters had expected that the essential benefits package would be based on the more generous benefits offered by large employers.

The letter also attacked the IOM panel for including members who have "amassed personal wealth through their involvement with health insurers and other for-profit health care firms."

Dr. Woolhandler, who served as an IOM fellow in 1990-1991, cited the inclusion of Sam Ho, executive vice president of UnitedHealthcare, and Leonard Schaeffer, former chairman and CEO of WellPoint.

Allowing individuals with financial ties to the insurance industry to serve on the IOM panel is contrary to the IOM’s own recommendations, issued in 2009, on minimizing conflicts of interest on panels that issue clinical practice guidelines, Dr. Woolhandler added.

Although Mr. Ho and Mr. Schaeffer have knowledge about the insurance business, there are many qualified experts without conflicts who could have been selected for the panel, she said. "A lot of people know about health insurance benefits," she said.

The IOM stood by the panel and its recommendations. "The IOM report speaks for itself and details the solid rationale for each of its recommendations for achieving a balance between coverage and cost," said Christine Stencel, an IOM spokeswoman.

The 18-member panel was chaired by Dr. John R. Ball, former executive vice president of the American Society for Clinical Pathology. The panel also included Dr. Alan Nelson, a health policy expert and retired internist/endocrinologist; Christopher F. Koller, health insurance commissioner for Rhode Island; and several policy experts.