Protecting High-Risk, High-Cost Patients: "Essential Health Benefits," "Actuarial Value," and Other Tools in the Affordable Care Act

The Affordable Care Act (ACA) will dramatically improve the nongroup and small group health insurance markets for everyone in them, including the high-risk population. But insurance reforms, guided by requirements for minimum or essential health benefits, insurance plan actuarial value and other tools provided by the ACA, are and will remain a work in progress. This analysis suggests the way these tools-working together and reevaluated over time-can most effectively ensure that ACA implementation progresses toward the goals of adequate and affordable insurance protection, especially for the highest-need, highest cost patients.