The 10 essential health benefits as defined by the Patient Protection and Affordable Care Act were viewed by the Obama administration as, well, essential. But the controversial list included coverage of many procedures and treatments that had formerly been only partially covered or not covered at all. In addition to objections raised by some based upon a religious belief, concerns were raised by others, including state agencies, about their ability to quickly shift to the EHB format.
The feds conceded that a transition period would be appropriate. As a result, states were given the option to select a set of EHBs in an already existing plan. Their choices:
- One of the three largest plans, by enrollment, in the state's small-group market;
- One of the state's three largest state employee plans;
- One of the three largest Federal Employees Health Benefit Program options;
- The state's largest non-Medicaid HMO.
A new report funded by the Robert Wood Johnson Foundation discovered "significant state variation in the essential health benefit packages" from state to state.
"State mandates [of benefits to be included in basic coverage plans] rarely reflect systematic decisions about the value and effectiveness of a particular service," the report noted. "The ACA was supposed to change that. It required that new plans sold on the individual market or to small groups include a package of "essential health benefits (EHBs)" that covered 10 broad categories. … For both political and practical reasons, DHHS chose to allow states to define their own EHBs in 2014 and 2015 by picking an existing benefits package offered by one of a number of "benchmark plans" in the state."
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
