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AHA weighs in on EHB proposed rule

December 20, 2012

The AHA today expressed concerns that the Centers for Medicare & Medicaid Services' proposed rule implementing the Patient Protection and Affordable Care Act's provisions relating to essential health benefits, actuarial value and accreditation "may have granted states and health plans too much flexibility, undermining the ACA's goal of extending meaningful and affordable coverage" to the uninsured or underinsured. "The definition of EHB is the cornerstone for determining whether the health coverage offered and purchased is truly meaningful - that is, ensuring the ability to respond to individuals' needs with coverage of services grounded in clinical, evidence-based guidelines," wrote Linda Fishman, AHA senior vice president for public policy analysis and development, in comments to the agency. "… While the AHA supports appropriate flexibility, we remain concerned that too much emphasis is being placed on providing flexibility and affordability rather than ensuring that coverage is meaningful." The AHA's comments are based on the EHB framework it first shared with the Institute of Medicine last year, which "looks to balance the availability of a comprehensive benefit package capable of meeting individual needs, with the need to keep the benefit package affordable by emphasizing broad coverage grounded in evidence-based clinical guidelines."