The future of essential health benefits

The concluding paragraph of my Upshot post today is a little out of date, it seems:

The secretary of H.H.S. must revisit the essential health benefits regulations for 2016. Another debate about what they are and how much discretion should be left to states is not far off.

That may have been correct when I drafted the piece, but toward the end of November, new, proposed regulations came out that clarified what HHS intends to do about essential health benefits. Tim Jost explained:

[The current] benchmark plans will apparently continue in place through 2016. The proposed rule would allow states to choose a new base benchmark plans for 2017.  These plans will be based on 2014 plans, adjusted to ensure that they meet all EHB requirements. HHS proposes, therefore, to begin collecting data on 2014 plans for the purpose of identifying benchmark plans, including administrative data and descriptive information pertaining to covered benefits, treatment limitations, drugs, and exclusions.  Apparently, HHS does not intend to establish its own EHB requirements in the foreseeable future, but rather to continue to rely on the benchmark approach.

Notice this is a proposed rule for 2017, so in theory there’s still opportunity for discussion and refinement (I guess). But it seems today’s standards will be in place through 2016, which isn’t quite what I wrote.

This does not change the main point of my piece. With respect to essential health benefits, the ACA still doesn’t impose a costly, one-size-fits-all standard, and it won’t going forward.

I thank Mitchell Stein for pointing out the discrepancy.


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