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Advocates press Biden to update Affordable Care Act essential benefits

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Eric Galatas

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(Colorado News Connection) The number of people with Affordable Care Act health coverage is on the rise, but many are not able to access the care they need to get and stay healthy. 

Adam Fox - deputy director of the Colorado Consumer Health Initiative - said the Biden Administration has an opportunity to update the ACA's Essential Health Benefits, services that almost all individual and small-employer insurance plans across the country are required to cover. 

He said all Americans need access to fundamental services.

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"Like dental, which is currently covered for children, but not adults," said Fox. "It should cover the full range of reproductive health services, and perinatal and postpartum care for people who are giving birth, as well as hearing and vision benefits."

Colorado has made some headway expanding benefits to address health care needs, including gender-affirming care and coverage for all people regardless of their immigration status. 

Some insurers providing coverage through the ACA have warned that expanding essential benefits will drive up insurance premiums and health care costs in general.

Fox said he believes updating essential benefits would actually lower costs, and improve the quality of health coverage for all people - whether they get insurance through ACA marketplaces like, employer-sponsored plans, or programs like Medicaid.

"The reality is many of these services, that are proactive and preventative care," said Fox, "help people maintain their health and avoid much more costly health interventions, are likely to save costs."

It's been more than 13 years since the Affordable Care Act established rules defining ten categories of health services that most insurance policies must cover. 

Fox noted that many states have not done anything to update or expand benefits.

"And what we need is federal action to update essential health benefits," said Fox, "ensure that the full range of whole person care is covered, and that that is made a requirement across the country."