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Marketplace Morning Report
Health reform

What’s ‘essential’ in health care

Jennifer Collins Mar 2, 2011
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Bob Moon: President Obama is offering to give states more lee-way in opting out of key requirements of the new federal health-care law. But he still wants them to meet the law’s objectives of providing affordable, comprehensive coverage. Under health care reform, Americans who buy insurance through health care exchanges are guaranteed access to essential medical care. But what’s ‘essential?’ The Institute of Medicine — which advises the government — is meeting in the next few days to hash that out.

Marketplace’s Jennifer Collins reports.


Jennifer Collins: Here’s the rub:

Tom O’Malia: Everybody’s definition of ‘essential’ is going to be different and unique.

Tom O’Malia teaches medical management at the University of Southern California. For instance, the law says maternity care should be covered. But does that include fertility treatments? Prescription drugs are ‘essential.’ But is Viagra? And what about speech therapy, say, for kids with autism? Stuart Spielman is policy advisor for Autism Speaks.

Stuart Spielman: We are talking about doing interventions that can change the direction of a child’s life; you know, this isn’t a frill.

But these treatments can drive up costs. Bradley Herring is a health economist at Johns Hopkins University.

Bradley Herring: So the fundamental tension is that the health insurance premium is going to, as a result, generally be a little more expensive.

The Institute of Medicine is expected to give its recommendations later this year.

I’m Jennifer Collins for Marketplace.

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