Sara Rosenbaum, Joel Teitelbaum, J.D., LL.M., and Katherine Hayes, J.D.
S. Rosenbaum, J. Teitelbaum, and K. Hayes, The Essential Health Benefits Provisions of the Affordable Care Act: Implications for People with Disabilities, The Commonwealth Fund, March 2011.
In establishing minimum coverage standards for health insurance plans, the Affordable Care Act includes an "essential health benefits" statute that directs the U.S. Secretary of Health and Human Services not to make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life. This issue brief examines how this statute will help Americans with disabilities, who currently are subject to discrimination by insurers based on health status and health care need. The authors also discuss the complex issues involved in implementing the essential benefits provision and offer recommendations to federal policymakers for ensuring that people with disabilities receive the full insurance benefits to which they are entitled.