What are Essential Health Benefits (EHBs)?
In the simplest of terms: Essential Health Benefits (EHBs) are the health care services that most health plans across the country must cover: services like pregnancy, maternity and newborn care; preventive and wellness care; emergency services; doctor visits; mental health and substance use disorder services, children’s vision and oral care, and more.
Despite the good intentions when this policy was developed 12 years ago, it has become clear that the benefits covered within insurance plans are not as comprehensive as intended.
The fight for health justice requires that we honestly assess what needs to change to make health a right for all — and to work towards that change every day. When it comes to minimum standards of coverage, or EHBs, making progress requires that we work to make EHB standards stronger so that the quality of health coverage improves for all people, whether they get health insurance through Marketplaces, their employer-sponsored plan, or programs like Medicaid.
Here are some EHBs inequities and inconsistencies the Biden administration must address
As more people come to count on EHB coverage standards, the Biden administration can build on its commitment to advancing health equity by improving benefits to ensure coverage allows everyone to get the care they want and need — without going into debt.
In July, led by Community Catalyst, more than 50 groups launched a campaign urging the Biden administration to expand coverage of Essential Health Benefits (EHBs), which have not been updated since the Affordable Care Act (ACA) became law 13 years ago. The groups are calling on the Health and Human Services Secretary Xavier Becerra and Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure to close gaps and inconsistencies, and adopt several health care services into the EHB framework, including oral health care, expanding maternity and postpartum care, gender affirming care, and behavioral health and substance use disorder benefits. Doing so would advance equity amongst communities that disproportionately face barriers to care due to racism, classism and other forms of oppression.