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The Patient Protection and Affordable Care Act (herein known as the
Affordable Care Act [ACA]) was signed into law on March 23, 2010.
Several provisions of the law went into effect in 2010 (including
requirements to cover children up to age 26 and to prohibit
insurance companies from denying coverage based on preexisting
conditions for children). Other provisions will go into effect
during 2014, including the requirement for all individuals to
purchase health insurance. In 2014, insurance purchasers will be
allowed, but not obliged, to buy their coverage through newly
established health insurance exchanges (HIEs)--marketplaces
designed to make it easier for customers to comparison shop among
plans and for low and moderate income individuals to obtain public
subsidies to purchase private health insurance. The exchanges will
offer a choice of private health plans, and all plans must include
a standard core set of covered benefits, called essential health
benefits (EHBs). The Department of Health and Human Services
requested that the Institute of Medicine (IOM) recommend criteria
and methods for determining and updating the EHBs. In response, the
IOM convened two workshops in 2011 where experts from federal and
state government, as well as employers, insurers, providers,
consumers, and health care researchers were asked to identify
current methods for determining medical necessity, and share
decision-making approaches to determining which benefits would be
covered and other benefit design practices. Essential Health
Benefits summarizes the presentations in this workshop. The
committee's recommendations will be released in a subsequent
report.
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