Dive Brief:
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At its interim meeting in Honolulu, the American Medical Association (AMA) on Tuesday adopted a policy that supports maintaining the Affordable Care Act’s (ACA) 10 essential health benefits (EHBs).
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The AMA said keeping the EHBs is a “step to ensure quality health insurance coverage."
- AMA’s new policy comes weeks after the CMS released a proposed rule that would allow states to sidestep the ACA’s EHBs.
Dive Insight:
The AMA warned that allowing payers to offer “plans with skimpier coverage” could lead to insurers’ plan designs possibly discriminating against people with pre-existing conditions. Changing EHB requirements could also cause patients to “face substantial increases in out-of-pocket cost,” according to the AMA.
The 10 EHBs in the ACA are:
- Emergency services.
- Hospitalization.
- Ambulatory patient services.
- Pregnancy, maternity and newborn care.
- Prescription drugs.
- Mental health and substance use disorder services, including behavioral health treatment.
- Rehabilitative and habilitative services and devices.
- Laboratory services.
- Prevention and wellness services and chronic disease management.
- Oral and vision for children.
The CMS recently released its proposed rule on EHBs after President Donald Trump issued an executive order in January suggesting the HHS “exercise all authority and discretion” to delay ACA provisions that impact members and states financially.
The AMA said its new policy opposes both removing EHBs and state waivers that could weaken the requirements. The waivers could remove protections against annual and lifetime limits and out-of-pocket expenses, warned the AMA.
EHBs are considered a key part of the ACA since the law requires that everyone in a qualified health plan have at least a base level of benefits. ACA critics, however, say EHBs raise healthcare costs. However, the Urban Institute disputes that claim. In July, the group released a report that said cutting EHBs will not reduce premiums much. EHBs make up less than 10% of total monthly premium dollars, according to the Urban Institute.
A May joint analysis by the Brookings Institution and the University of Southern California found that allowing states to define EHBs would “weaken ACA protections against catastrophic costs for people with employer coverage nationwide.”
AMA President Dr. David Barbe argues most of the costs associated with EHBs are connected to inpatient, outpatient, physician services and prescription drugs, which are necessary. “These services are fundamental components of health insurance coverage. Removing any categories from the EHB requirements, or allowing waivers of such requirements, could make individuals vulnerable to significant out-of-pocket expenses, or hinder patient access to necessary services,” Barbe said in a press release.
AMA also suggested reinsurance programs as one way to stabilize health insurance premiums for high-cost and high-risk patients. The group noted similar programs were used to stabilize individual insurance markets for those with pre-existing conditions prior to the implementation of the ACA, arguing reinsurance is “an economical and equitable mechanism to subsidize the expenses of high-cost and high-risk patients.”