Virginia Senator Kaine seeks Affordable Care Act health insurance changes

Health insurance - ACA Virginia Flag

Along with Senator Baldwin, changes to the ACA Essential Health Benefits are sought

Senator Tim Kaine (D-VA) and Senator Tammy Baldwin (D-WI) are seeking to update the Essential Health Benefits in Affordable Care Act health insurance plans.

The current ACA plans are required to cover 10 categories

Among the categories Affordable Care Act health insurance plans must cover are mental health services and prescription drugs.

Health insurance - ACA Coverage - medications and mental health

According to Virginia Health Catalyst CEO Sarah Bedard Holland, failure to act will only allow the current medical debt crisis to worsen.

“Four in 10 adults nationally have medical debt because they understand the importance of some of these services that aren’t covered,” said the consumer healthcare advocate. “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.”

Health insurance in its current state isn’t preventing widespread medical debt

According to nonprofit Kaiser Family Foundation (KFF) data, about 580,000 people in Virginia alone are experiencing medical debt.  When compared with the population of the state, that is near the national average, said the KFF.

Earlier in April, the US Department of Health and Human Services finalized a policy that provided all US states with the power to update their benchmark for Essential Health Benefits so that it would include adult dental services, beginning with next year’s application process.  Currently, children are required to have dental coverage, but adults are not.

Senators Kaine and Baldwin argued that additional health insurance benefits have been needed for a long time, particularly since the pandemic has eased.

Coverage gaps are the result of the original modeling of ACA plans

According to Community Catalyst policy director Colin Reusch, the reason that coverage gaps are present in the ACA health insurance plans is that they were modeled on employer plans, particularly when it comes to separate benefits.  He added that over the last 14 years since the ACA began, what has been learned is that coverage must be inclusive.

“Those standards just aren’t up to par, in terms of what people’s actual health care needs are,” said Reusch. “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.”

Still Congressional division may make it challenging to arrive at an agreement regarding the way benefits should be updated.

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