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The American Public Health Association's (APHA) Criteria for a Public Plan

Health & Medicine Policy Research Group (HMPRG)
August 20, 2009

1. All individuals and families shouldbe eligible for the public plan, regardless of income.

2. The public planmust be affordable to consumers. Affordability means the costs to consumersincluding any premium, copayments, or out of pocket costs

3. The public plan should serve as a model that shifts theemphasis of health systems from acute medical care toward prevention andwellness by:
  • Enhanced provider payments for prevention and earlyintervention
  • First dollar coverage of clinical preventive healthservices
  • Moving to outcome based reimbursement payments
  • Requiring theuse of health information technology (IT)
  • Requiring linkage to the nation’spublic health system
  • Using proven population based strategies at theprovider, health plan and community level
4. Coverage should at aminimum use the actuarial equivalent of the Federal Employees Health BenefitPlan standard option benefit package and should
include the following publichealth services:
  • Evidence-based clinical preventive services
  • Behavioral health services
  • Dental & vision care
  • Reproductivehealth services
  • Disease management
5. The public plan should ensurethe inclusion of the current network of safety net providers.

6. Thepublic plan’s practices and policies should serve as a model for affordabilityfor other health plans within the existing health system. This should bereflected in setting provider payments, which should also be adequate enough toensure patient access to providers. The plan must be organized and governed tobe administratively efficient, keeping administrative costs low consistent withother public programs.

Link to APHA statement on the EQUAL site from the Center for Policy Analysis' Health Reform & Public Health Testimony & Comments.