WASHINGTON — Sen. Tim Kaine, D-Va., wants to update the 14-year-old Affordable Care Act.
He and Sen. Tammy Baldwin, D-Wis., are asking for updates to the Act’s list of Essential Health Benefits. Affordable Care Act plans must cover 10 categories, including mental health services and prescription drug coverage.
Sarah Bedard Holland, CEO of Virginia Health Catalyst, said inaction will only further the medical debt crisis.
“Four in 10 adults nationally have medical debt because they understand the importance of some of these services that aren’t covered,” Bedard Holland pointed out. “They are either choosing to access care or in very emergent situations, and need to be paying out of pocket to access care that is fundamental to their overall health.”
Around 580,000 Virginians have medical debt, close to the national average. Dental benefits are optional for adults but mandatory for children.
This month, the Department of Health and Human Services finalized a policy allowing all states to update their Essential Health Benefits benchmark to include adult dental services, starting with the 2025 application process.
The senators argued getting more benefits has long been needed, especially post-pandemic.
Colin Reusch, policy director for the group Community Catalyst, said coverage gaps stem from Affordable Care Act plans modeled after employer plans, especially with separate benefits. Now, he noted the prevailing wisdom is to make health care inclusive.
“Those standards just aren’t up to par, in terms of what people’s actual health care needs are,” Reusch contended. “Luckily, the law is clear in saying these things can change and that the administration can recognize the need to improve and strengthen those standards.”
But the divisiveness in Congress could make it difficult to reach agreement on updating benefits. Past legislation sought to eliminate Essential Health Benefits for Medicaid expansion beneficiaries but was later amended to include individual and small-market plans.
