Letters and Correspondences
Joint Letter: Review the Essential Health Benefits as part of the ACA as it relates to children
First Focus on Children sent the following letter signed by 53 additional organizations to U.S. Department of Health and Human Services Secretary Xavier Becerra and Centers for Medicare & Medicaid Service Administrator Chiquita Brooks-LaSure urging them to strengthen and align coverage standards across private and public insurance programs and address inequitable barriers to essential health care services
Excerpt from the letter:
Since 2014, there have been considerable changes to the implementation of the ACA and plan offerings on the health insurance marketplaces. Increased competition and enhanced premium subsidies reduced costs for people across income levels and drove record enrollment. However, the ACA’s underlying approach to defining EHBs remains largely unchanged, relying on the initial state benchmark plan approach to defining the ACA’s ten categories of Essential Health Benefits. As a result of the benchmark plan approach, there is considerable variation in EHB coverage across states and, historically, many states defaulted to less generous small group benchmark plans. We are concerned about the inequitable access to critical services caused by such 2 variation, including access to prescription drugs, mental health and substance use disorder (SUD) treatment, maternal and reproductive health services, gender-affirming health care, and pediatric services. In addition, the benchmark approach has left significant gaps in coverage for other necessary preventive, ambulatory and chronic disease services such as oral health care. As a result, the EHB framework has not kept up with clinical evidence or the needs of the enrollee population. The undersigned organizations continue to hear that these gaps and inconsistencies in coverage are of particular concern for the health and economic well-being of low-income and marginalized populations who struggle to access and afford the care they need.