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‘Essential Benefits ’ will help state residents stay healthy, control costs

As a registered nurse and advocate for effective health policy, I’m excited that Idahoans have new resources available through the state insurance exchange to improve their health and control health care costs. Idahoans now have access to insurance benefits that they may not have had before. And many families will qualify for premium assistance through the Your Health Idaho marketplace.

How have benefits changed? The “10 Essential Benefits” now included in every policy sold ensure that Idahoans can access common sense, sometimes life-saving care. These benefits cover services shown to improve health, prevent disease, and protect individuals, families and businesses from avoidable catastrophic healthcare expenses.

Maternity and prenatal care: There’s ample evidence that women who receive good prenatal care give birth to healthier babies who grow up to be healthier children and adults. Inadequate care during pregnancy may lead to poor development, chronic illnesses, and problems learning. These babies are not only our children, they are our grandchildren, our neighbor’s children, and future Idaho leaders.

Preventive care and chronic disease treatment: Prevention is the best way to protect our health and it pays to monitor and treat chronic conditions rather than wait until a worsening condition requires an expensive visit to the emergency room or a hospitalization.

Mental health and addiction treatment: In the past, it was common to exclude or significantly limit mental health and substance abuse treatment from insurance benefit packages. This left individuals and families who could not afford to purchase these services waiting until the untreated situation escalated to a crisis. Families were told their children could not qualify for state-supported services until their illness was so severe that they came to the attention of law enforcement, or became a danger to themselves or others. It’s estimated that a third of our prison population and up to one third of emergency room visits are related to mental health needs. Now, access to these services upfront will likely lead to earlier diagnoses, effective intervention and treatment, stronger families and safer communities.

Prescription drugs: We have seen prescription drug prices far outpace the rate of inflation for years. Coverage for prescription drugs means individuals won’t have to choose between food and medications, or cut their pills in half to stretch their supply. It never made sense to me that people could access coverage to diagnose their condition, but then received no benefit in their policy to treat the condition!

People ask me how all these changes to our health care system will do anything to lower cost and improve quality of care. Inclusion of these 10 Essential Benefits in insurance policies is part of the answer. Preventing disease, discovering illness and cancer in the early stages, taking prescriptions as directed, giving children the best possible start in life, facilitating the recovery of those with mental illness are proven ways to improve the health of our community and save money. Paying now, rather than paying more later, is just common sense.

If you want to learn more about the 10 new “Essential Benefits”, you can find the full list on the Your Health Idaho website (

Margaret Henbest is a registered nurse, former state legislator and executive director of the Idaho Alliance of Leaders in Nursing. She also serves on the Your Health Idaho board of directors.


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