As Trump puts essential benefits on the table, opponents say the move would create 'skimpy' plans
There may be as many as 30 Republicans poised to vote down the bill on Thursday.
As voting on the American Health Care Act is expected to take place Thursday, reports say the White House is open to removing the bill's requirement that insurers at a minimum cover essential health benefits outlined in the Affordable Care Act. The move would likely appease Conservative Republicans, but it also threatens to erode more moderate Republican support for the bill.
Despite working late into the night Wednesday, multiple reports say that provision was not officially stripped from the bill, and there may be as many as 30 Republicans poised to vote down the bill that President Donald Trump, Speaker Paul Ryan and HHS Secretary Tom Price have hailed as the best option to repeal and replace the ACA.
[Also: Republicans make changes to healthcare bill]
The ACA initially required insurers to cover these 10 essential health benefits: Ambulatory patient services (outpatient services), emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care.
Conservatives say these requirements drive up premiums because they limit insurers from offering cheaper, more basic plans. But opponents say having minimum requirements protects the insured from the potentially high costs of unexpected health issues.
Larry Levitt, senior vice president of the Kaiser Family Foundation, on Wednesday, posted a detailed thread on Twitter outlining why he thinks essential health benefits are ... essential:
With no benefit requirements, insurance policies could get quite skimpy. No insurer wants to be the one most attractive to sick people.
-- Larry Levitt (@larry_levitt) March 22, 2017
With no requirements, benefits could even be skimpier than pre-ACA. That's because insurers can no longer turn away people who are sick.
-- Larry Levitt (@larry_levitt) March 22, 2017
It's counter-intuitive, but repealing benefit requirements doesn't make the AHCA cheaper. Tax credits vary by age, but not actual premiums.
-- Larry Levitt (@larry_levitt) March 22, 2017
In fact, with no benefit rules, premiums would come down and more people might buy insurance and get tax credits, raising federal costs.
-- Larry Levitt (@larry_levitt) March 22, 2017
If there were no federal benefit rules, a key question is whether states would step in and enact their own requirements.
-- Larry Levitt (@larry_levitt) March 22, 2017
Interestingly, only three states required insurers to cover prescription drugs pre-ACA.https://t.co/QOUUOYeTAm
-- Larry Levitt (@larry_levitt) March 22, 2017
The idea of tailoring health benefits has an understandable free market appeal. But often, people don't know in advance what they'll need.
-- Larry Levitt (@larry_levitt) March 22, 2017
The AHCA's continuous coverage requirement wouldn't have much meaning if there were no definition of what a policy had to cover.
-- Larry Levitt (@larry_levitt) March 22, 2017
If insurers have to guarantee coverage for people with pre-existing conditions, they'd be very hesitant to offer comprehensive benefits.
-- Larry Levitt (@larry_levitt) March 22, 2017
The ACA's essential benefit requirement also includes the limit on patient out-of-pocket costs. Would that be repealed too?
-- Larry Levitt (@larry_levitt) March 22, 2017
If there were no cap on patient out-of-pocket costs, insurers could offer very high deductible (and very low premium) plans.
-- Larry Levitt (@larry_levitt) March 22, 2017
It's worth noting that Congressional Republicans have been quite consistent in advocating repeal of the ACA's benefit requirements.
-- Larry Levitt (@larry_levitt) March 23, 2017
The idea of a la carte benefits is really a return to health status rating, too. For example, who would buy a policy with mental health?
-- Larry Levitt (@larry_levitt) March 23, 2017
With no required benefits, some (like mental health or maternity) would be very expensive because only people who need them would buy them.
-- Larry Levitt (@larry_levitt) March 23, 2017
The AHCA's tax credits are set dollar amounts that don't vary with actual premiums, so they don't depend on what benefits are covered.
-- Larry Levitt (@larry_levitt) March 23, 2017
Insurers would no doubt come up with skimpier products that could be purchased for the amount of the AHCA's tax credits.
-- Larry Levitt (@larry_levitt) March 23, 2017
It's almost certainly the case that repealing benefit requirements would raise the cost of the AHCA since more people would use tax credits.
-- Larry Levitt (@larry_levitt) March 23, 2017
With no benefit rules, more people would technically have insurance as premiums came down. Question is how many would meet CBO's criteria.
-- Larry Levitt (@larry_levitt) March 23, 2017
Some of the fallout from the AHCA could land on governors, who would have to decide on Medicaid and potentially benefit requirements.
-- Larry Levitt (@larry_levitt) March 23, 2017
Twitter: @HenryPowderly
Contact the author: henry.powderly@himssmedia.com
