Perspective--the need for public deliberation: giving the public a voice on affordable health insurance.

Affordability is a key consideration in debates about the mandate for Americans to buy health insurance as required by the 2010 Patient Protection and Affordable Care Act. Yet no universally agreedupon standard exists for determining what constitutes affordable health insurance. The question, then, is how best to make decisions about what is affordable. The articles in this issue by Peter Muenning, Bhaven Sampat, Nicholas Tilipman, Lawrence D. Brown, and Sherry Glied and by Carole Roan Gresenz, Miriam J. Laugesen, Ambeshie Yesus, and José J. Escarce both present thoughtful and useful ways to make decisions about affordability standards. Using what we might call the authoritativeexpert judgment approach, Muening and colleagues asked eighteen well recognized affordability experts to define affordability and to decide what should be included in an affordability standard. In what we might call the policy analytic measurement approach, Gresenz and colleagues examine what three states are actually using in Medicaid and Children’s Health Insurance Programs (CHIPs) and then develop metrics for comparing premium costs for similar families across the three states with a final assessment of affordability. There is a third approach for thinking about affordability: listening to what the public has to say. In addition to understanding the perspective of experts and the measurement assessments of policy analysts, it is important to listen to the voice of the people. Where is the voice of the public in either article? Clearly, affordability experts care about making decisions