§ 18022(b):[5] Health insurance plans must cover these benefits i.e. they must cap people's out-of-pocket spending and must not limit annual and lifetime coverage.
The secretary (1) must "ensure that such essential health benefits reflect an appropriate balance among the categories ... so that benefits are not unduly weighted toward any category"; (2) may "not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life"; (3) must take into account "the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups"; and (4) must ensure that essential benefits "not be subject to denial to individuals against their wishes on the basis of the individuals’ age or expected length of life or the individuals' present or predicted disability, degree of medical dependency, or quality of life.
"[1]: 3–4 According to a Commonwealth Fund report in 2011: As it stands, federal regulations for 2014 and 2015 do not establish a single, nationally uniform package of health services.
Instead, the U.S. Department of Health and Human Services (HHS) gave states discretion to determine the specific benefits they deem essential.
Groups representing consumers and providers were less supportive, however, expressing concern that the degree of flexibility found in the rules undermines the law's promise of consistent, meaningful coverage.