Hobby Lobby decision will not broadly affect concept of ‘essential health benefits’ says UB health policy expert

BUFFALO, N.Y. – The Supreme Court’s decision to allow Hobby Lobby to refuse to provide contraceptive coverage for employees in Burwell v. Hobby Lobby Stores does not broadly threaten the fundamental principle of essential health benefits in the Affordable Care Act, says Nancy H. Nielsen, MD, PhD, senior associate dean for health policy in the University at Buffalo School of Medicine and Biomedical Sciences.  

“This case was a challenge to the part of the health care law that requires employers to offer birth control coverage without copay,” says Nielsen, also a professor in the UB Department of Medicine. The law, she noted, applied to non-grandfathered health plans. Grandfathered plans are those that existed prior to the passage of the ACA in 2010 or those that have not made significant changes to benefits or copays.

The Affordable Care Act, Nielsen explains, has a provision that non-grandfathered health insurance plans must make certain preventive services available without copays or deductibles; the U.S. Department of Health and Human Services HHS determined that those preventive services for women included contraception.

“The ACA mandated that the Department of Health and Human Services should determine what constituted essential health benefits, based on advice from an Institute of Medicine panel,” says Nielsen, an IOM member.

Nielsen was invited to serve on that IOM panel but could not, as she had by that time agreed to take a position with the Centers for Medicare and Medicaid Innovation. The panel provided criteria for evaluation and inclusion but did not enumerate specific benefits.  Nevertheless, this is a case she has watched closely.

“In their decision, the justices went out of their way to say this doesn't extend to all insurance mandates, like blood transfusions and vaccinations,” says Nielsen. “So I don’t think this will have bigger implications beyond the contraception issue, although the number of opting-out employers will probably grow.”