If upheld, the ruling risks critical aspects of the American health care system, including mandatory coverage of essential health benefits
, a prohibition on lifetime and annual caps of coverage, prescription drug coverage for millions of seniors due to the re-opening of the Medicare donut hole, and the guarantee that children can stay on their parents' insurance until the age of 26.
On November 7, 2018, the Trump administration issued proposed regulations that would require Affordable Care Act (ACA) Marketplace plans to issue separate bills to individuals who have abortion coverage as part of their benefit package--one to cover the premiums for Essential Health Benefits
, and another to cover the costs of abortion coverage.
The North Dakota Plan would cover all essential health benefits
but would allow higher cost sharing compared to the ACA metal level plans.
"All of these options are risky and may or will not provide comprehensive health coverage for essential health benefits
compared to enrolling in an ACA plan," Insurance Commissioner Jessica Altman, said in a statement.
Additional new policy was adopted that opposes the sale of individual and small group policies that do not guarantee pre-existing protection and coverage of essential health benefits
That all changed with the ACA, which required that all individual market insurers cover "essential health benefits
," a defined set of basic health services that consumers have access to under their health coverage.
One of the most important changes gives states greater flexibility in selecting an Essential Health Benefits
They might be able to leave out some of the benefits required by the ACA essential health benefits
package, and, unlike ACA-complaint small-group plans, they might be able to offer plans that cover less than 60% of the actuarial value of the essential benefits package.
"ANA urges Senators to craft bipartisan legislation that protects Americans from being denied coverage because of pre-existing conditions, protects essential health benefits
, and improves quality, affordability and access.
Allowing insurers to remove essential health benefits
House of Representatives debated and approved their version of the American Health Care Act --legislation to undermine or repeal key pillars of the ACA--they included a provision allowing states to rewrite what constitutes "essential health benefits
," with maternity care cited by numerous conservatives as something that not all insurance plans should be required to cover.
The AHCA retains Obamacare's prohibition on lifetime and annual limits for essential health benefits
. Under existing law, employers can use any state's interpretation of the ACA's 10 essential benefits to base group coverage.