Nominee To Run CMS, Seema Verma, Might Water Down ACA’s 10 Essential Benefits

The ACA mandates that health care benefit packages sold to individuals and small groups look like plans offered in a typical employer-sponsored package and “those are still pretty generous.” That’s Timothy Jost, an emeritus professor at Washington and Lee University Law School, explaining to Kaiser Health News why GOP officials are considering watering down the 10 essential benefits that the ACA says must be covered. Republicans do not have the 60 votes needed to repeal and replace, as of this writing, but they do have the necessary majority needed to change existing law.


And they have could have someone overseeing CMS that could make such watering down possible. President Trump’s nominee to head CMS, Seema Verma, said at her confirmation hearing last week that plans for individuals and small groups should not be forced to cover maternity services, one of the 10 essential benefits. What’s the sense if someone is a man or is too old to get pregnant?


The other essential services are:


  • ambulatory patient services
  • emergency services
  • hospitalization
  • mental health and substance use disorder services, including behavioral health treatment
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • laboratory services
  • preventive and wellness services and chronic disease management
  • pediatric services, including oral and vision care

“Since the 10 required benefits are spelled out in the Affordable Care Act, it would require a change in the law to eliminate entire categories or to water them down to such an extent that they’re less generous than typical employer coverage,” Kaiser Health News reports, adding that “policy experts say there’s room to ‘skinny up’ the requirements in some areas by changing the regulations that federal officials wrote to implement the law.”


Source: Kaiser Health News