Texas Running Out of Time to Decide Which Benefits Will Be Essential Under Health Law

July 6, 2012                                                Contact: Christine Sinatra    (512) 473-2274

Over 20 Statewide and Regional Organizations Call on State Leadership to Act by Deadline

AUSTIN, Texas—Health care reform puts affordable health insurance within reach for more Texans, but the state must decide in the coming months whether that coverage includes some of the specific prescriptions, procedures and treatments that many Texans count on. Earlier this week, 21 statewide and regional organizations—ranging from the Texas Medical Association to the March of Dimes to the Children’s Hospital Association of Texas—called for Texas to begin a process of defining what falls within 10 categories of “essential health benefits” that many insurance policies must cover beginning in 2014.

“This is one of the most important regulatory tasks required under the nation’s health law, and it warrants an open and thoughtful decision-making process,” said Stacey Pogue, Senior Policy Analyst with the Center for Public Policy Priorities. “Essential health benefits are about how our state defines good and comprehensive health coverage for Texans.”

The groups signing on to the letter, including patient and consumer advocacy groups, health care provider associations and other health care stakeholders, asked Texas Department of Insurance Commissioner Eleanor Kitzman and Health and Human Services Commissioner Tom Suehs to convene a diverse workgroup to review proposed “benchmark plans” for essential health benefits. Under the nation’s health care law, which was upheld last week by the Supreme Court, 10 categories of benefits need to be included in many health plans, including plans sold to individuals and small employers as well as Medicaid coverage for newly eligible adults.  Starting in 2014, these health plans will have to provide benefits at least equivalent to those found in Texas’ chosen benchmark plan. The deadline for decisions about the state’s benchmark plan is September 30th of this year.


The Texas Well and Healthy Campaign is a broad, grassroots coalition working to ensure that every Texan has access to comprehensive and affordable health insurance. Following the Supreme Court decision, we are offering a series of concrete ways that Texas can get to work on implementing health care reform. Learn more at: http://texaswellandhealthy.org.

Cover Texas Now