Step Guide to Updating States’ Essential Health Benefits Benchmark Plans

Executive Summary

A step-by-step guide for state health care advocates to fight for robust coverage of the Affordable Care Act’s Essential Health Benefits (EHB). The guide by National Health Law Program Staff Attorney Hayley Penan follows a new rule from Trump’s HHS that gives states greater flexibility to weaken the ACA’s 10 EHB categories, but prevents states from expanding or fully providing essential health care benefits, which include ambulatory services, emergency care, hospitalization, maternity and newborn care, mental health and substance use disorder care, prescription drugs, rehabilitative and habilitative care, preventive care for people living with chronic diseases, and pediatric care, including oral and vision services. Penan urges in the conclusion of this guide for advocates to “strongly oppose state attempts to offer less comprehensive coverage” in their essential health base-benchmark plans.

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