What are Essential Health Benefits?

Last week the Senate released their health care bill, known as the Better Care Reconciliation Act of 2017 (BCRA). I feel like I have been living and breathing healthcare since the moment the text was released. My anxiety is reminiscent of 2014 when the formidable LCD was released. After learning more about the bill, my immediate response was correct. Amputees in this country are in for a battle when it comes to maintaining insurance coverage for prosthetics.

Through our podcast Amp'd, Dave and I have been warning about a looming battle over Essential Health Benefits. We have been at the forefront of this issue since the beginning. Now EHB's are being heavily dissected and debated on every major news network. I think we should brag that we were talking about Essential Health Benefits before they were cool! 

As a quick refresher, EHB's are a core set of 10 benefits that each insurance policy must cover. These benefits are mandated because they were deemed essential to living an active and healthy life. All insurance policies must include these benefits. It is important to consider that an EHB classification does not mean that the benefits are available without a co-payment, but rather the insured is protected by the mandate that the co-payment will be the same rate as other comparable items in the insurance policy. The insured is still required to fill their financial obligation in order to receive the prosthetic care.  EHB's are not subject to yearly or lifetime caps.

The ten categories deemed Essential Health Benefits include:

•  ambulatory patient services;
  
•  emergency services;
  
•  hospitalization;
  
•  maternity and newborn care;
  
•  mental health and substance use disorder services, including behavioral health treatment
•  prescription drugs;
• Rehabilitative and Habilitative services and devices (this is the category that includes prosthetic devices and other mobility aids)
  
• laboratory services
• preventive and wellness services and chronic disease management;
•  pediatric services, including oral and vision care.

As we feared, the BCRA eliminates mandates for Essential Health Benefits. In this legislation, EHB's will be decided by the state, which will contribute to increasing disparities in prosthetic care across this country. With the elimination of EHB's, amputees can expect to see a return to yearly and lifetime caps on prosthetic coverage. Unrealistic and devastating caps of $10,000 per lifetime will keep prosthetic devices out of reach for many in this country, especially children and those who are economically vulnerable.

If the BCRA is adopted as in its draft form, the amputee community will become a casualty of politics. Those who need prosthetic devices will be forced to rely upon other mobility aids simply because they lack the coverage and funds. I am imploring you to contact your Senators and urge them to maintain Essential Health Benefits in any health care legislation. Sample letters can be found on our amp'd website through this link. Please don't wait for somebody else to speak up on your behalf.  This is our battle, and it is time that our voices are heard on this issue.