Essential Health Benefits Standards Must Meet Guarantees of Affordable Care Act

Washington, D.C.— The U.S. Department of Health and Human Services (HHS) today released a pre-regulation bulletin that addresses the definition of the minimum Essential Health Benefits health insurance coverage standard across 10 required categories of health services, a protection for consumers who purchase insurance that is included in the Affordable Care Act. The following is the statement of Ron Pollack, Executive Director of the consumer health organization Families USA, about this bulletin:

“The Affordable Care Act extends many critical protections to health care consumers. One of the most important is the reassurance that, when a consumer buys an insurance plan, he or she can count on it to cover essential health services—and not be riddled with unexpected benefit holes and coverage limits. This is especially important for many low- and middle-income families who can’t afford the necessary medical care that their doctor recommends if it is not covered by their health insurance.

“The Department of Health and Human Services today took a first step in a process that we hope will ultimately result in a clear, strong, and more uniform standard of what a reasonable health insurance plan must cover in every state. The pre-regulation bulletin helps make it possible to preserve important existing state benefit requirements. Moving forward, it will be important to ensure that adequate coverage is provided across all 10 required benefit categories—marking an improvement over many plans offered today.

“We understand the inclination to balance flexibility, comprehensiveness of coverage, and cost in developing the Essential Benefits standard. However, any flexibility must yield to reliable, comprehensive coverage of benefits for consumers—guaranteed by the Affordable Care Act. It is essential that HHS provide strong oversight and enforcement of Essential Health Benefits standards as they are implemented in the states, which we expect to see when the formal regulations are issued.”

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Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan and advocates for high-quality, affordable health care for all Americans.

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202-628-3030 · Email: info@familiesusa.org · www.familiesusa.org