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Insurance; Health Reform


The essential health benefits statute is unique. Because its legislative history is quite limited, the text itself takes on particular importance. The provisions of the statute differ significantly from the highly detailed coverage terms of Medicare Parts A and B. Similarly, its provisions differ from the coverage provisions of the Employee Retirement Income Security Act, which governs virtually all private employer-sponsored health benefit plans and which (with the important exception of the insured small group market) remains unaffected by the essential health benefits provision. In referencing broad benefit categories, the essential health benefits statute bears some resemblance to the structure of the Medicaid benchmark coverage statute and the Children's Health Insurance Program (CHIP). At the same time, however, the statute is substantially more robust and in certain respects carries echoes of Medicaid's heretofore unique non-discrimination rule.


Statement delivered to the Institute of Medicine, Committee on the Determination of Essential Benefits.

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