In late-night negotiations to woo enough Conservative holdouts into passing the repeal and replacement of ObamaCare, House Republicans reportedly offered to remove the mandate for coverage of essential health benefits. Their argument: it would make plans cheaper and provide political cover by increasing the number of Americans who buy insurance under their new law.
What are Essential Health Benefits?
EHB’s (in the lingo) are “a set of 10 categories of services health insurance plans must cover under the Affordable Care Act,” according to healthcare.gov. “These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.” Plans must also cover children’s visits to the dentist as well.
According to a study by Milliman, a firm that studies healthcare costs, the most likely and vulnerable services that Republicans would be likely to cut from the health care law are:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions to gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness service and chronic disease management
- Pediatric services, including oral and vision care
Why Republicans would offer to eliminate essential health benefits
Republicans need about 21 more votes in the House to pass their version of repeal and replace the American Health Care Act, or AHCA. In an effort to lure votes, The L.A. Times reported that House leaders offered to eliminate the mandate that these essential services be covered. There is a faulty logic one can make that essential health benefits cost more than the revenue they bring in through premiums, giving the illusion of savings for everyone by cutting them. However, the Times concluded, in short, that this is “a stupid idea that won’t save money,” as their headline reads.
“Eliminating the most vulnerable mandates,” the Times noted “will reduce average premiums somewhat but drive costs for people who need those services sky-high and transfer much of the cost to other public programs. The net gain for society is almost invisible. To put it another way, the savings are an illusion.”
In fact, offering to eliminate EHB mandates will likely cost the government more.
As the Times analyzed, without established standards like essential health benefits, “insurers would offer plans that are skimpy, but priced just low enough to be covered by the tax subsidies that are part of the GOP repeal bill. Perversely, more Americans would use their subsidies — to buy lousier insurance. This would be the worst of all possible worlds: more federal spending, on crappy coverage that doesn’t really protect its buyers from risk.”
Just how far are Republicans willing to go to pass their hastily-compiled healthcare replacement?
This gives a pretty clear idea. Not only are they willing to take coverage away from 14 million Americans, but they are willing to sell a replacement that doesn’t actually cover anything in the process. Bravo.
Featured image from Flickr