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. 2013 Mar;9(2):73-7.
doi: 10.1200/JOP.2012.000881.

Analyzing the affordable care act: essential health benefits and implications for oncology

Valerie A Hutchins  1 , Marc B Samuels, Angela M Lively
Affiliations

Analyzing the affordable care act: essential health benefits and implications for oncology

Valerie A Hutchins et al. J Oncol Pract. 2013 Mar.

Abstract

The Patient Protection and Affordable Care Act (ACA) will have lasting effects on oncology coverage and, perhaps, on oncology practice as well. The ACA ushers in a new class of insured individuals; approximately 25 million will purchase insurance through the exchanges, and Medicaid will expand by 12 million beneficiaries over the next 10 years. Essential health benefits (EHBs), which are required in all qualified health plans (QHPs) sold in the exchanges, will define the coverage available to the newly insured population and could lead to the development of new definitions and standards for medical necessity. This article will discuss effects of the ACA EHB requirements on oncology coverage, as well as the state and federal options and responsibilities as they relate to coverage of and access to oncology services within the QHPs in the exchanges.

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Figures

Fig 1.
Fig 1.
Exchange timeline. EHB, essential health benefit; HHS, Department of Health and Human Services; QHP, qualified health plan.
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References

    1. Patient Protection and Affordable Care Act of 2010. 2010. Pub L 111-148, 124 Stat 119.
    1. United States Department of Labor, Bureau of Labor Statistics. Selected medical benefits: A report from the Department of Labor to the Department of Health and Human Services. http://www.bls.gov/ncs/ebs/sp/selmedbensreport.pdf.
    1. Institute of Medicine. Essential health benefits: Balancing coverage and cost. http://www.iom.edu/Reports/2011/Essential-Health-Benefits-Balancing-Cove....
    1. Center for Consumer Information and Insurance Oversight. Essential health benefits bulletin. http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_be....
    1. Patient Protection and Affordable Care Act. Standards related to essential health benefits, actuarial value, and accreditation—Proposed rule. Federal Register. 2012;77:70644–70676. - PubMed

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