What the GOP’s plan to kill essential health benefits means

Greg Nash

The pivotal debate in the fight over ObamaCare is whether to kill “essential health benefits” in the law that mandate certain coverage areas for insurers.

House Republicans are now discussing a deal that would do away with the requirements, which might win conservative votes but risks losing centrists.

But what would it mean for healthcare in the United States?

The essential health benefits mandate included in ObamaCare was intended to require insurance companies to provide coverage in 10 areas, including mental health, pediatric dental and vision care, maternity care, and prescription drugs.

{mosads}The idea behind the move was to prevent insurers from offering skimpy plans that would leave people on the hook for thousands of dollars in costs if their plan doesn’t cover certain services.

Republicans argue the requirements drive up premium costs by preventing insurers from offering less-generous plans. They say consumers should be allowed to pick cheaper plans and that a single man, for example, has little need for maternity coverage.

Getting rid of the essential health benefits would almost certainly lower premium costs, though it could also leave many consumers holding health insurance that might not cover various maladies.

Larry Levitt, a healthcare policy analyst at the Kaiser Family Foundation, wrote on Twitter Wednesday night that without the essential benefits, “premiums would come down.”

But on the flip side, he wrote, insurance plans could become very skimpy, because insurers would be wary of offering generous plans and attracting only sick, costly people who were willing to pay more for them.

“With no benefit requirements, insurance policies could get quite skimpy. No insurer wants to be the one most attractive to sick people,” he wrote.

“With no required benefits, some (like mental health or maternity) would be very expensive because only people who need them would buy them,” he added.

There is little doubt that the requirements have led insurers to offer broader plans.

Jeanne Lambrew, one of the White House architects of ObamaCare, earlier this year pointed to a Department of Health and Human Services report from 2011 that showed how plans have changed.

In 2011, the report showed that 62 percent of individual market plans did not cover maternity care, 34 percent did not cover substance abuse services, 18 percent did not cover mental health coverage and 9 percent did not cover prescription drugs.

It’s not clear if the repeal of the essential health benefits would be enough to put the bill over the top.

Some House Freedom Caucus members say it’s not enough and that they also want to repeal other insurance regulations that can be found in Title I of ObamaCare. Those include the ban on discrimination against people with pre-existing conditions, a limit on out of pocket costs and a ban on lifetime limits on insurance coverage.

Democrats also warn that repeal of the essential health benefits will never be allowed under Senate rules governing the “reconciliation” procedure Republicans are using to avoid a filibuster.

“What the proponents aren’t telling conservative House Republicans is that the plan to repeal essential health benefits will almost certainly not be permissible under Senate reconciliation rules,” said Matt House, a spokesman for Senate Minority Leader Charles Schumer (D-N.Y.). “It will require 60 votes to repeal these protections, and the votes just aren’t there in the Senate.”

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