Ahead of the ACA anniversary this weekend we are seeing growing momentum – from lawmakers on the Hill to advocates to new polling – for the administration to act and expand Essential Health Benefits (EHBs). 

On Capitol Hill:

This week, we saw action in the Senate urging the Biden administration to act. On Wednesday, five Senators sent a letter to “strongly urge the Department [of Health and Human Services] to initiate rulemaking to update and revise the EHBs.” 

In the letter, the Senators wrote:

Given the Secretary’s clear regulatory authority, and the persistent gaps in coverage identified above, HHS should take immediate action to:

  1. Expand the scope of services within the current EHB categories, where appropriate, through the review process; 
  2. Institute a minimum standard of coverage that applies to every EHB category, with sufficient detail to ensure a nationwide floor for coverage by most health plans; and
  3. Establish a permanent structure for regularly reviewing and updating EHBs that is transparent, equitable and prioritizes meaningful opportunities for stakeholder engagement.

The effort was co-led by Sen. Tim Kaine (D-VA) and Sen. Tammy Baldwin (D-WI) and was joined by Sens. Markey, Smith and Lujan. 

Advocates:

The momentum on Capitol Hill is being matched by momentum from around the country. This week, Community Catalyst sent to HHS a petition signed by more than 13,000 people from all 50 states demanding, “Our health can’t wait — we need to expand Essential Health Benefits now.” The petition builds on a letter that was sent last year by more than 50 organizations pushing HHS to act. 

New Polling:

All this momentum follows new polling commissioned by Community Catalyst from HIT Strategies that found:

  • Despite the fact that the vast majority of voters are insured, many voters nationally are still struggling to afford health care costs and/or their insurance plan;
  • 90% of voters believe that making health care more affordable should be a priority for the Biden administration;
  • 83% of voters support dental care as part of what insurance companies must cover;
  • And nearly 7 in 10 voters would feel more favorable towards a policymaker that supported efforts to make dental care more affordable and accessible. 

*** Survey conducted online with 1,400 registered voters nationally including 4 oversamples: 100 Black, 100 Latino/a, 100 AAPI, and 100 young (ages 39 and under) voters. Survey was conducted February 21-28, 2024. Margin of error of +/- 2.84%.

In reaction to all the action this week, Emily Stewart, executive director of Community Catalyst issued the following statement:

“Thirteen years after ACA passage, we are seeing growing momentum for the administration to act in the spirit of the law and update the ACA’s standards to fill in crucial gaps and make health insurance coverage more comprehensive. Now more than ever, it’s time for HHS to act, as there are major inequities in the services covered, leaving far too many people underinsured resulting in high out-of-pocket costs and medical debt, or people foregoing important, needed care. With rising health care costs, and 4 in 10 adults with medical debt, it’s critical that policymakers continue to address the gaps and inconsistencies that exist – including for mental health, maternity and dental care. This is a simple yet important and long overdue action the Biden administration can take to improve coverage for millions of people across the country. We applaud the lawmakers urging action.”

As always, it’s important to remember this is not some abstract policy debate happening in Washington. While the Biden administration has taken important steps in allowing states to strengthen EHB standards, the gaps in federal policy are having real world consequences for hundreds of thousands of people. In the last few months alone, we’ve heard from hundreds of people, including:

  • I have Rheumatoid Arthritis. Inflammation begins in my mouth and has ruined my teeth! I can’t get help without paying a fortune. They hurt every day. – Jennifer
  • I’m on Medicaid and need root canal and tooth replacement and can’t afford it. – Barbara
  • $10,000.00 in dental this year, and counting. – Peter
  • I have headaches every day from teeth that I can’t afford to care for. – Jessica
  • They cut our benefits for prescription glasses. Now, since I can barely afford groceries and pay my rent I can forget being able to afford a $800+ pair of new glasses. – Roberta
  • After having a normal, routine birth with two forms of medical insurance, I was left with over $6,000 in debt and little after birth support. – Sara
  • Couldn’t afford mental health care for my teenage son…  – Cynthia
  • We need more streamlined care, especially for mental health. – Cherry
  • Because dental and mental health care should be treated as essential health services for all. – Karen
  • It’s devastating to be told that your essential medical care is denied and you can’t afford to pay for it yourself. – Jan
  • Please add dental, vision and hearing to basic health care plans now! – Mary
  • Having proper health care can mean the difference between living and dying. It can make or break the quality of life for an entire family. – Cori
  • I’m drowning in medical debt and bills. – Tabitha
  • Everything constantly gets worse instead of better because I’m going further and further into medical debt each year, and I’m only 46. – Kelly
  • It’s ridiculous to wait months or even years to get some services covered by insurance. – Marcela
  • Complete coverage is a basic human right. – Jeff
  • Help is urgently needed. – Paula
  • The need is urgent and vital. – Natasha

More on Community Catalyst’s efforts to address the gaps and inconsistencies in Essential Health Benefits here.