Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455-0392, USA,
Health Care Anal. 2013 Dec;21(4):355-71. doi: 10.1007/s10728-011-0197-5.
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.
根据 HealthCare.gov 的说法，通过改善所有美国人获得优质医疗保健的机会，平价医疗法案（ACA）将减少医疗保险覆盖范围方面的差异。在 ACA 的规定下，实现这一目标的一种方式是在 2014 年前创建一个新的医疗保险市场（医疗保险交易所），在这个市场中，“即使失业、换工作、搬家或患病，所有人都将有选择优质、负担得起的医疗保险的机会”。这并不意味着每个人都可以选择他或她想要的任何保险。ACA 的规定要求四类计划的福利类别（称为青铜、白银、黄金和白金）都提供不少于“基本健康福利套餐”中提供的福利。然而，如果没有清楚地了解什么是必要的医疗保健，那么 ACA 的要求就太模糊了，容易产生多种潜在的冲突解释。事实上，如果没有这样的理解，在急于为尽可能多的人提供医疗保险的过程中，我们可能会用另一种差距（缺乏足够的医疗保险）来取代一种差距（缺乏医疗保险）。因此，本文探讨了“基本福利”的概念，认为 ACA 中的“基本健康福利套餐”应该是能够最优化满足所覆盖人群基本需求的福利套餐。
