Happening Right Now: Essential Health Benefits
While the budget process moves on, conversations are underway about the impact of the Supreme Court decision to uphold the Affordable Care Act (ACA). Of particular interest to the paralysis community is the impact this ruling will have on determining state coverage requirements for essential health benefits.
Under the new health care law, most health insurance plans (including new plans to be offered in the state health insurance exchanges) are required to cover at least the following essential benefits: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.
For individuals with disabilities, the inclusion of rehabilitation and habilitation services in the initial list of essential benefits is a step in the right direction. Many people with disabilities rely on such services and, prior to health reform, many insurance policies did not cover them or severely limited the number of treatments allowed.
HHS is proposing to define essential health benefits using what is known as a benchmark approach. Under this approach, each state will have flexibility to select a benchmark plan, from a list of 10 designated plans, to serve as the state's standard for essential health benefits.
The Reeve Foundation strongly supports many important provisions of the Affordable Care Act (ACA) that bring the country one step closer to ensuring that all Americans, including people living with spinal cord injury and paralysis, have access to high quality, comprehensive, affordable health care that meets their individual needs and enables them to be healthy, functional, and live as independently as possible.
As HHS and states move forward in the process of defining essential benefits, the Reeve Foundation is actively working to ensure that the needs of people living with spinal cord injury and paralysis are taken into account.