The ACA and the “Essential Benefits Package”

Sabrina CorletteGeorgetown University Health Policy Institute

From Vision to Reality: State Strategies for Health Reform Implementation

November 12, 2010

Scope of Coverage: What Benefits will Plans Provide Under Reform?

Getting to Accessible, Adequate, Affordable Coverage

Essential Benefits Package: Critical to Adequate Coverage

Essential Benefits Package: Categories of Coverage under the ACA

•Ambulatory patient services•Emergency services•Hospitalization•Maternity and newborn care•Mental health and substance abuse services, including behavioral health treatment•Prescription drugs•Rehabilitative and habilitative services and devices•Laboratory services•Preventive and wellness services and chronic disease management•Pediatric services, including oral and vision care

Essential Benefits Package: Who Has to Offer it?

Essential Benefits Package: What’s next

•Department of Labor survey•IOM study•HHS regulation defining items and services within each category•What’s left for health plans to decide?

Essential Benefits Package: Impact on State Mandates

•23 states have autism mandates•25 states have cancer-related mandates•46 states have diabetes-related mandates•14 states have infertility-related treatment mandates•51 unanswered questions!

Scope of Coverage: What Benefits will Plans Provide Under Reform?

Thank you!

Sabrina CorletteResearch Professor

Georgetown UniversityHealth Policy Institute