Federal Policy
AHA Urges CMS to Preserve Essential Health Benefits Coverage Standards in RFI Response
The American Hospital Association submitted comments July 15 responding to a CMS request for information on potential modifications to the Affordable Care Act's Essential Health Benefits framework. AHA supported updating EHBs to reflect changes in healthcare delivery but warned against changes that would reduce coverage adequacy. The association emphasized that affordability requires adequate benefits, not just lower premiums, and cautioned that reduced benefits, narrower standards, or increased cost-sharing would increase patient financial exposure. CMS is reviewing the EHB framework, which establishes minimum coverage requirements for comprehensive insurance.
Why it mattersAny CMS modifications to Essential Health Benefits standards would affect benchmark plans that many state Medicaid programs use to define alternative benefit packages for expansion populations, potentially requiring managed care organizations to adjust covered services and prior authorization protocols.