Daily Briefing Blog

The states with the most—and least—comprehensive ACA plans


Clare Rizer, Daily Briefing

As mandated by the Affordable Care Act (ACA), all health plans sold on the insurance exchanges must cover "essential" services. But for reasons of politics and practicality, HHS let states outline the exact essential health benefits (EHB) required in plans sold on their exchanges.

So it's no real surprise that ACA plans vary significantly from state to state. A new report from the Robert Wood Johnson Foundation (RWJF)—which we covered in today's Daily Briefing—shows just how much variation exists.

Click here to see our full coverage of the RWJF report

Using the data in the report, we identified the states that offer the most—and least—comprehensive health care coverage based on whether they provide coverage for 11 condition-specific services, such as bariatric surgery, infertility treatments, and autism spectrum disorder therapies.

The states with the most comprehensive coverage are:

  • Illinois, which requires coverage for nine  of the 11 services;
  • New Mexico, which requires coverage for eight of the 11 services;
  • Nevada, which requires coverage for eight of the 11 services;
  • Arkansas, which requires coverage for seven of the 11 services;
  • Arizona, which requires coverage for seven of the 11 services;
  • Maryland, which requires coverage for seven of the 11 services;
  • North Carolina, which requires coverage for seven of the 11 services;
  • New York, which requires coverage for seven of the 11 services; and
  • Rhode Island, which requires coverage for seven of the 11 services.

The researchers note that a state's EHBs tend to reflect the politics and health priorities of that state. So it's not too surprising that of the nine states that offer at least seven of the services outlined in the RWJF report, only North Carolina has not opted to expand its Medicaid program.

Meanwhile, the states with the least comprehensive coverage are:

  • Pennsylvania, which requires coverage for one of the services;
  • Utah, which requires coverage for one of the services;
  • Alabama, which requires coverage for two of the services;
  • Idaho, which requires coverage for two of the services;
  • Nebraska, which requires coverage for two of the services; and
  • South Carolina, which requires coverage for two of the services.

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