Panel to define 'essential' benefits under health care reform law

Health care end-of-the-year checkup.

Jeremy Hobson: This week in London, I've been paying more attention to the exact words I use to communicate -- because words that mean one thing in the U.S. might mean something slightly different here -- like bathroom, or chips. Well today, at the White House the question is what does essential mean? Because under the new health reform law, insurance companies will be required to pay for a set of essential benefits.

A task force of scientists from the Institute of Medicine is going to offer a recommendation today on the meaning of "essential," as Gregory Warner reports now from the Marketplace health desk at WHYY in Philadelphia.


Gergory Warner: If you're a drug firm, a medical device maker, or a specialist doctor society, this list of essential benefits coming out is huge.

Dan Mendelson: This is an influential list, because what it does is gives instruction to all the health insurance companies as to what they need to cover.

Dan Mendelson is CEO of Avalere Health. He says the Institute of Medicine will make public their recommendations on how to decide what's essential -- anything from a lung cancer test to a smoking cessation program.

Georges Benjamin is executive director of the American Public Health Association.

Georges Benjamin: Obviously everyone wants their test to be on the list. So the most important thing is that there be an evidence base that it works.

But "what works" is not always obvious. Just last night it was reported that a key federal advisory panel will recommend that healthy men should not be screened with a popular test for prostate cancer. The PSA test -- used by millions -- the panel found causes more unnecessary treatments and saves almost no lives.

In Philadelphia, I'm Gregory Warner for Marketplace.

About the author

Gregory Warner is a senior reporter covering the economics and business of healthcare for the entire Marketplace portfolio.

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