Overview of Changes to the Essential Health Benefits Standards in NBPP 2019

Executive Summary

The U.S. Department of Health and Human Services (HHS) is advancing a new rule intended to greatly weaken the Affordable Care Act’s “Essential Health Benefits Standards,” by allowing insurers to create plans that do not include all of the ACA’s ten categories of essential health care services, such as hospitalization, emergency care, ambulatory patient services, prescription drugs and preventive and wellness services and chronic conditions. National Health Law Program attorneys Candace Gibson, Héctor Hernández-Delgado, Hayley Penan, and Wayne Turner conclude in this issue brief that HHS’s rule on essential health care benefits will cause many people seeking health care to receive far less comprehensive coverage. Although HHS touts its new rule as providing greater flexibility to states to craft health care plans, the only flexibiliy offered is for states to peddle inadequate health care plans — there is no ability in HHS’s rule for states to offer health care coverage plans that offer more robust essential health care benefits.

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