By NextBestFitTask 1.5.1 of 7
Enact statutory benefit categories: hospital, physician, outpatient, mental health & substance use, maternity & newborn, prescription drugs, lab & imaging, rehabilitation & habilitation, dental, vision, hearing, home- and community-based long-term services, and the clinical component of nursing-facility care.
Who does it
Congress
When
Drafting
Trade-off
Broad statutory categories maximize protection but raise utilization and cost.
Part of: Define the benefit package & cost sharing
Write down exactly what UHP covers, what it excludes, and what patients pay at the point of care: nothing for covered services. Out-of-pocket spending falls from $556.6B to $197.3B; what remains is for excluded items.
This step changes 14 existing laws, programs, or institutions. See the list.