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INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions.

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  • Additional Information
    • Subject Terms:
    • Abstract:
      The Affordable Care Act (ACA) establishes essential health benefits as the coverage standard for health plans sold in the individual and small-group markets for all fifty states and the District of Columbia, including the health insurance Marketplaces. “Pediatric services” is one of the required classes of coverage under the ACA. However, other than oral health and vision care, neither the act nor the regulations for implementing it define what these services should be. We investigated how state benchmark plans—the base plan chosen in each state as the standard or benchmark of coverage in that state under ACA rules—address pediatric coverage in plans governed by the essential health benefits standard. Our review of summaries of all the state benchmark plans found that no state specified a distinct pediatric services benefit class. Furthermore, although benchmark plans explicitly included multiple pediatric conditions, many plans also specifically excluded services for children with special health care needs. The Department of Health and Human Services has made a commitment in the essential health benefits regulations to review its approach for the 2016 plan year. Thus, our findings have implications for future regulations regarding the essential health benefits standard for pediatric services. [ABSTRACT FROM AUTHOR]
    • Abstract:
      Copyright of Health Affairs is the property of Project HOPE/HEALTH AFFAIRS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
    • Author Affiliations:
      1Fellow in general academic pediatrics, Children's National Health System, in Washington, D.C.
      2Codirector, PolicyLab
      3Member, Division of General Pediatrics, Children's Hospital of Philadelphia
      4Faculty member, Master of Public Health Program, University of Pennsylvania, Philadelphia
      5Chair, Department of Pediatrics, Johns Hopkins Bayview Medical Center
      6Professor of pediatrics and public health Johns Hopkins University School of Medicine, Baltimore, Maryland
      7Division chief, general pediatrics and adolescent medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
      8Research Scientist, health law and health policy, PolicyLab, Children's Hospital of Philadelphia
      9PolicyLab, Children's Hospital of Philadelphia
      10Codirector of the PolicyLab
      11Professor of pediatrics, Perelman School of Medicine, University of Pennsylvania
      12Harold and Jane Hirsh Professor of Health Law and Policy, Milken Institute School of Public Health, George Washington University, Washington, D.C.
    • ISSN:
      0278-2715
    • Accession Number:
      10.1377/hlthaff.2014.0743
    • Accession Number:
      99905991
  • Citations
    • ABNT:
      GRACE, A. M. et al. INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions. Health Affairs, [s. l.], v. 33, n. 12, p. 2136–2143, 2014. DOI 10.1377/hlthaff.2014.0743. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=99905991&custid=s8280428. Acesso em: 7 ago. 2020.
    • AMA:
      Grace AM, Noonan KG, Cheng TL, et al. INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions. Health Affairs. 2014;33(12):2136-2143. doi:10.1377/hlthaff.2014.0743
    • APA:
      Grace, A. M., Noonan, K. G., Cheng, T. L., Miller, D., Verga, B., Rubin, D., & Rosenbaum, S. (2014). INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions. Health Affairs, 33(12), 2136–2143. https://doi.org/10.1377/hlthaff.2014.0743
    • Chicago/Turabian: Author-Date:
      Grace, Aimee M., Kathleen G. Noonan, Tina L. Cheng, Dorothy Miller, Brittany Verga, David Rubin, and Sara Rosenbaum. 2014. “INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions.” Health Affairs 33 (12): 2136–43. doi:10.1377/hlthaff.2014.0743.
    • Harvard:
      Grace, A. M. et al. (2014) ‘INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions’, Health Affairs, 33(12), pp. 2136–2143. doi: 10.1377/hlthaff.2014.0743.
    • Harvard: Australian:
      Grace, AM, Noonan, KG, Cheng, TL, Miller, D, Verga, B, Rubin, D & Rosenbaum, S 2014, ‘INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions’, Health Affairs, vol. 33, no. 12, pp. 2136–2143, viewed 7 August 2020, .
    • MLA:
      Grace, Aimee M., et al. “INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions.” Health Affairs, vol. 33, no. 12, Dec. 2014, pp. 2136–2143. EBSCOhost, doi:10.1377/hlthaff.2014.0743.
    • Chicago/Turabian: Humanities:
      Grace, Aimee M., Kathleen G. Noonan, Tina L. Cheng, Dorothy Miller, Brittany Verga, David Rubin, and Sara Rosenbaum. “INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions.” Health Affairs 33, no. 12 (December 2014): 2136–43. doi:10.1377/hlthaff.2014.0743.
    • Vancouver/ICMJE:
      Grace AM, Noonan KG, Cheng TL, Miller D, Verga B, Rubin D, et al. INSURANCE COVERAGE. The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions. Health Affairs [Internet]. 2014 Dec [cited 2020 Aug 7];33(12):2136–43. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=99905991&custid=s8280428