Health Insurance

Here’s what the GOP bill does to Obamacare’s ‘essential health benefits'

Maggie Fox
Protesters demonstrate outside the White House in Washington, DC, on March 23, 2017, against President Donald Trump and his plans to end Obamacare. After several failures to repeal the ACA, last week Trump stopped federal payments that have been key to subsidizing ACA coverage for low-income Americans. He also cut the budget to market the ACA during open enrollment season.
Kevin Lamarque | Reuters

Maternity care. Mental health. Dentist visits for kids. States trying to save money on health insurance are likely to ask to cut these and other services if the latest version of the GOP's health reform bill becomes law, the Congressional Budget Office found.

The CBO's analysis of the American Health Care Act breaks out how many states are likely to seek permission to stop requiring health insurance companies to offer coverage of all of the "essential health benefits" — the list of medical services that must be offered now under the Affordable Care Act.

"In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year," according to the CBO report released Wednesday.

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Bare-bones policies that don't cover these conditions will certainly be cheaper, the CBO said. But only for people who don't need them covered. Everyone else is likely to be priced out of the market, the non-partisan group said.

"The CBO … confirmed that by allowing states to opt out of the Essential Health Benefits, patients would be left with inadequate coverage that will not suffice for patients when they need it most," said Harold Wimmer, CEO of the American Lung Association.

"The Affordable Care Act is not perfect but any changes to current law should prioritize preventing disease and preserving healthcare coverage for all Americans — regardless of income or pre-existing conditions," he added.

"CBO has confirmed what the March of Dimes and other advocates have been saying for weeks: Women and their families will pay higher costs and receive less coverage, especially for maternity care, under the American Health Care Act," Stacey Stewart, president of the March of Dimes, which funds research to prevent birth defects, said.

"People living in states modifying the essential health benefits who used services or benefits no longer included in the essential health benefits would experience substantial increases in out-of-pocket spending on health care or would choose to forgo the services," the CBO said.

@larry_levitt: Shorter CBO:Reduces the deficit.Still lots more people uninsured.Some states do waivers (OK for healthy people, lousy for sick people).

"Services or benefits likely to be excluded from the essential health benefits in some states include maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits."

This version of the AHCA was particularly difficult for the CBO to analyze, because it leaves many options open to states, which are the final regulators of health insurance.

The CBO predicted states where about half of all Americans live would keep the essential benefits requirements, which are very popular with American voters who had tired of insurance companies that refused to cover pre-existing conditions and that capped coverage.

In those states, premiums are likely to go down a little, the CBO projected.

But other states are likely to seek waivers that would let insurance companies charge more for some care, and charge older people much more than they charge younger people, the CBO said.

And some people who need, for instance, expensive drugs could end up paying huge amounts out of pocket if states let insurance companies impose lifetime caps — currently banned by Obamacare.

In states where about a sixth of the population lives, the CBO economists projected, coverage would become pricey as insurance companies went back to the practice of charging far more for pre-existing conditions and far more for older people.

"Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly," the CBO said.

Medical groups were predictably unhappy with the CBO projections.

@larry_levitt: CBO: A "few million" people would use federal tax credits to buy policies that don't count as health insurance.