Framework for a Health Care System Guaranteeing Access to Quality Health Care for All

August 20, 2020

The National Breast Cancer Coalition’s number one public policy priority is guaranteed access to quality health care for all. This document outlines a framework developed by NBCC’s Board of Directors that is based on the organization’s Principles for Guaranteed Access to Quality Health Care for All adopted in 2003. This framework addresses a legislative approach to coverage issues. NBCC recognizes that access to quality health care goes beyond coverage.

A health care system that is built on this framework will:

      •  Provide a basic benefits package that is comprehensive and based on sound scientific evidence.
      •  Maintain continuity of coverage.
      •  Be efficient and cost-effective.
      •  Be fully-funded through shared financial responsibility.
      •  Be sustainable and affordable.

The health care system must be accountable to the users and the public. A system must be established to:

      •  Evaluate and support development of medical evidence for health interventions upon which coverage will be based.
      •  Support ongoing and continuous comparison of interventions to ensure access to appropriate and cost-effective health care.
      •  Modify and expand current benefits as appropriate based on evidence.

I. Benefits Package

1.  All eligible individuals will be provided with coverage for a benefits package equivalent to the most comprehensive plan available to Members of Congress through the Federal Employees Health Benefit Plan.

2.  The benefits package guarantees coverage for care that is based on the best available scientific evidence and is cost effective (as determined by the Federal board described below). Care that does not meet these criteria will not be covered, unless it is being provided as part of a quality clinical trial or otherwise appropriately contributing to the further development of the evidence base.

II. Eligibility

1.  Coverage is guaranteed to all eligible individuals.

      • An eligible individual is one who is present in the United States. (Note: The extent of coverage will vary based upon reason for presence and duration of stay.)

2.  All eligible individuals will be automatically enrolled and covered at the point of attaining eligibility.

III. Determination of, Modifications to and Expansion of Benefits:

1.  A Federal-level board shall have the authority to implement a system of coverage determination based on evidence. The board shall be appointed and include members representing the lay public (at least 25%). The members shall have staggered terms longer than four (4) years.

      • Cost-effectiveness shall be a factor considered by the board in making benefit coverage decisions.

2.  A separate and independent body, including at least 25 percent membership from the lay public, shall be appointed to develop a system for assessing comparative effectiveness of interventions, the results of which must be utilized by the board determining coverage benefits.

3.  The comprehensive benefits package and any modifications thereto shall be limited to those interventions that the boards deem to be efficacious, safe, cost-effective, based on sound evidence or either as part of a quality clinical trial or otherwise appropriately contributing to the evidence base.

4.  Elective Benefits

      • Commercially available private health plans may provide coverage of benefits not included in the benefit package.

IV. Efficiency

1.  The government shall implement strategies to significantly reduce the current administrative costs of the health care system and all such savings shall go toward providing coverage.

2.  The government shall also develop and implement strategies to simplify the current system, reduce duplication, inaccuracies, and inefficient record keeping and provide for system-wide, interoperable electronic record keeping.

V. Information and Education

1.  Accurate, timely, and readily accessible information about health care coverage, access and the scientific evidence base shall be available to everyone. All health care providers must offer clear information to consumers on the benefits and harms of all options, and the quality of the evidence for each option.

2.  A national panel shall be established to work with the public to review evidence and help design effective methods for communicating health care information to consumers, providers and plans.

VI. Financing

1.  All individuals are required to financially contribute to the system according to their ability to pay.

2.  All employers also are required to financially contribute to the system. Under this framework employer-sponsored health insurance will be phased out, however, all employers are required to financially contribute to the system.

3.  The federal government shall establish a method for determining the financial contributions for individuals and employers.

4.  No individual can be denied coverage because of inability to pay.

5.  In addition to individual and employer contributions, the system will be financed by the public and private savings from efficiencies (referred to in the section on efficiency) as well as other government funding sources.