A small group of House Democrats expressed concern about HHS allowing states to determine the definition of essential health benefit packages.

Reps. Henry Waxman (D-Calif.), Sander Levin (D-Mich.) and George Miller (D-Calif.), ranking members, respectively, on the House Energy and Commerce, Ways and Means and Education and the Workforce Committees, sent a letter to HHS Secretary Kathleen Sebelius (PDF) about the essential health benefits bulletin that HHS' Center for Consumer Information and Insurance Oversight issued in mid-December. The lawmakers contend that when they wrote the Patient Protection and Affordable Care Act, the essential health benefits package was intended as a federal decision, and that one of the primary goals of the healthcare reform law was to create a consistent and comprehensive level of coverage for Americans nationwide.

They further said they support defining essential health benefits at the state level to protect state benefit requirements, so long as the process to do so is an open one.

“The ACA is intended to expand transparency so consumers can better understand their choices,” said the letter, which was also signed by Reps. Frank Pallone (D-N.J.), Pete Stark (D-Calif.), Robert Andrews (D-N.J.) and John Dingell (D-Mich.). “Defining the EHBs is a critical step,” it continued. “At a minimum, there should be reporting requirements inserted into the process.”

Other parts of the seven-page letter covered benefit design flexibility, meaningful coverage, defining “habilitative” services and pharmacy benefits. Some healthcare groups submitted their own comments on the bulletin to HHS last week.