Comment on CMS-2026-2081-0001

Dear Administrator, I am writing as a practicing board-certified family medicine physician. I received my MD degree and completed my family medicine residency at Baylor College of Medicine in Houston, Texas. In my daily practice, I manage a wide range of primary care and women’s health issues, including infertility and reproductive health concerns. I submit these comments on the Request for Information regarding the Essential Health Benefits (EHB) Framework and the “typical employer plan” standard (File Code CMS-9874-NC). The ACA requires that EHB be equal in scope to benefits provided under a typical employer plan and maintain an appropriate balance among the ten statutory benefit categories. As a physician, I urge CMS to define EHB narrowly, based on medical necessity, evidence-based standards, and what is actually typical in employer-sponsored coverage. Topic 1: Typical Employer Plans and Typicality (Questions 1.1–1.3) A proper assessment of “typical employer plans” should focus on the plan level and give significant weight to smaller employers and self-funded plans. These plans generally do not cover elective, high-cost, or ethically problematic interventions as core benefits. Topic 4: Scope of Benefits Included as EHB (Question 4.2) CMS should add explicit exclusions for services that are not medically necessary, lack strong long-term evidence, or involve serious ethical concerns under a secular, personhood-based framework. I recommend excluding: Procedures that involve the surgical or hormonal mutilation of healthy human sexual anatomy (sex-rejecting or gender-affirming interventions). These procedures carry significant risks of irreversible harm, infertility, sexual dysfunction, and regret. Long-term outcome data remain limited, and they do not align with typical employer plan coverage. In-vitro fertilization (IVF) and related assisted reproductive technologies (ART). IVF is an elective procedure that routinely involves the creation and destruction of human embryos. From a secular perspective grounded in personhood — recognizing the biological reality that a new human organism exists at fertilization — the routine destruction or indefinite cryopreservation of embryos raises profound ethical concerns. IVF is also expensive, has variable success rates, and often leads to multiple pregnancies with associated maternal and neonatal risks. Instead of mandating coverage for IVF, CMS should support (via guidance and education rather than new mandates) Restorative Reproductive Medicine (RRM). RRM uses evidence-based medical and surgical treatments to diagnose and correct underlying causes of infertility, such as hormonal disorders, endometriosis, or ovulatory dysfunction. These approaches align with the statutory EHB category of chronic disease management and focus on restoring normal reproductive function rather than bypassing it. In my clinical experience, many patients prefer restorative options that respect the integrity of the human body and avoid embryo destruction. Similar concerns apply to certain abortifacient drugs and devices that can end the life of an early human embryo. These should remain excluded or carefully limited, consistent with existing statutory treatment of abortion under EHB. These exclusions can be implemented through the actuarial adjustment mechanism already used for abortion coverage, so that federal subsidies do not support non-essential services. Affordability and Cost (Topic 3) Many of the above procedures are high-cost with uncertain or poor long-term value. Excluding them from EHB would help control premiums and improve affordability for individuals and small businesses. Physician and Patient Considerations From a medical ethics standpoint, physicians should not be compelled to participate in or facilitate procedures they view as harmful or unethical. A narrower EHB definition protects patient safety, clinical judgment, and the integrity of medical practice. I support periodic review of the EHB package (Topic 5) to ensure it reflects current medical evidence, typical employer offerings, and sound ethical standards grounded in biological reality and personhood. Thank you for the opportunity to provide these comments based on frontline clinical experience. Refining the EHB framework to exclude elective, high-risk, and ethically problematic services while supporting restorative approaches would better serve patients and promote a more sustainable health insurance system.