The repeal of Medicare payroll tax on high income employee wages has been postponed until 2023.
Patient and State Stability Fund
As we have discussed previously, the AHCA establishes the Patient and State Stability Fund to be used by states to provide financial assistance to hi-risk consumers, stabilize and reduce individual market insurance premiums, promote participation in the individual insurance market, promote preventive care, or reduce out-of-pocket costs.
This amendment adds maternity and newborn care to the permissible ways states may use this funding. This amendment also increases funding for this fund by $15 billion and provides that this funding must be used by states for maternity coverage/newborn care and mental health/substance use disorders.
Essential Health Benefits
Under the ACA, all plans must cover the same categories of medical treatment, called Essential Health Benefits. These categories are currently decided by the federal government and include the following:
Ambulatory patient services
Pregnancy, maternity, and newborn care
Mental health and substance abuse services
Rehabilitative and habilitative services
Preventive and wellness services
Pediatric services, including dental services
The amendment specifies that each state will determine what essential benefit categories must be covered by plans sold in the state.