As we are now entering the implementation of the Affordable Care Act (“Obamacare”, “ACA”), it will be interesting to see how each State decides coverage for their residents.  Although the Act has several mandates, it appears that each State has some latitude in how the Act is implemented.  The Affordable Care Act requires that health insurance plans sold to individuals and small businesses provide a minimum package of services in 10 categories called “essential health benefits.” These categories include hospitalization, maternity and newborn care, ambulatory care, and prescription drugs, to name a few.  But rather than establishing a national standard for these benefits, the Department of Health and Human Services (HHS) decided to allow each state to choose from a set of plans to serve as the benchmark plan in their state. Whatever benefits that plan covers in the 10 categories will be deemed the essential benefits for plans in the state.  Although flexibility and State by State choice according to local issues sounds reasonable on the surface, a federal benchmark definition of “essential health benefits” may have been a better choice given the complexity and magnitude of regulation this Act may require.

The most significant impact of the ACA for those with disabilities is the end to preexisting conditions.  Access to providers, affordability and prohibitions on lifetime dollar value limits on covering care and services are also important features.  Massachusetts residents will benefit from expanded funding for community health centers, assistance with prescription drugs for seniors, and increase the income limits to qualify for public subsidies.