In a bid to appeal to conservative Republican lawmakers who still oppose the American Health Care Act, White House officials are working to eliminate a provision under the ACA that requires payers to cover 10 essential health benefits, reports Politico.
Initially, conservatives criticized the AHCA for not striking the provision that requires all health plans provide essential health benefits, saying the bill doesn't do enough to lessen regulations on insurers or lower premiums. Now, ahead of a possible floor vote on the AHCA in the House today, Mick Mulvaney, White House budget director, and Rep. Mark Meadows, R-N.C., chairman of the conservative House Freedom Caucus, are working together to cut the mandate, according to the report.
The provision mandating coverage for essential health benefits was included in the ACA to prevent insurers from offering cheap plans that would make patients shoulder the costs of many basic health services.
If the rule requiring coverage for the essential health benefits is eliminated, health plans won't have to cover a wide range of medical and health services, including: emergency services, ambulatory patient services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitation services and devices, laboratory services, preventive and wellness services and pediatric services.
There are two key possible consequences of this.
1. Premium costs would probably drop. Larry Levitt, senior vice president for special initaitives at the Kaiser Family Foundation, on March 22 tweeted that without essential health benefits "premiums would come down," according to The Hill.
2. Many policies would be significantly pared down and certain benefits would be more expensive. Without required coverage for essential health benefits across all plans, insurers would likely offer fewer generous plans out of fear the only people who would be willing to pay more for them would be sick people who need them. "No insurer wants to be the one most attractive to sick people," Mr. Levitt wrote, according to the report. "With no required benefits, some (like mental health or maternity) would be very expensive because only people who need them would buy them."
More articles on payer issues:
Humana to stay out of exchange business, AHA opposes Anthem-Cigna appeal, Affinity Health Plan appoints CEO & more — 8 payer highlights
Humana reports 3% drop in 'Unhealthy Days' under Bold Goal initiative
Temkin: Consumers rate health plans among poorest performing industries