Obamacare's "essential health benefits" could be in jeopardy

WASHINGTON — Scrambling to nail down votes for the House health care bill, Republicans are considering ways to ease federal requirements that insurers cover such basic services as prescription drugs, maternity care and substance abuse treatment.

Lawmakers emerging from a meeting late Wednesday of the conservative Freedom Caucus said “essential health benefits” are in play as party leaders and the White House explore ways to advance the House legislation. But undermining the Affordable Care Act’s benefits is likely to trigger a backlash from patient groups and doctors.

It’s also a tricky proposition for Republican lawmakers, because Democrats are certain to challenge any such move as out-of-bounds under special budget rules that would allow the GOP health bill to clear the Senate with just 51 votes. Until now, the ACA’s benefit requirement had not been considered a budgetary issue.

Traditionally, states have regulated the benefits that health insurers offering plans to individual consumers must provide. But the Obama-era health care law set a minimum floor for the whole nation.

The ACA’s “essential benefits” include outpatient care, emergency services, hospitalization, pregnancy, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, rehabilitation, laboratory and diagnostic tests, preventive and wellness services, and pediatric care, including dental and vision services for kids.

In a letter to congressional leaders early this year, organizations representing nearly 400,000 doctors said “all health insurance products should be required to cover evidence-based essential benefits” in any new health care legislation. The letter was signed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American College of Physicians. Many other organizations have taken a similar stance.

The required benefits are considered especially significant for women, since birth control and other routine women’s health services are now covered at no charge to patients.

Some White House officials have also acknowledged privately that essential health benefits are among the list of potential changes under discussion. While declining to elaborate on specifics, spokeswoman Sarah Huckabee Sanders said, “We’re open to changes that help make the bill better.”

Republican advocates of undoing the federal benefits requirement say it drives up the cost of insurance. For example, before the ACA, a married couple in their early 60s might be able to purchase a policy that did not include maternity benefits. Now, the cost of caring for pregnant women and newborns is spread among the entire pool of people purchasing individual policies.

Doctors say plans with cherry-picked benefits have a way of backfiring on consumers, because you can never tell in advance what kind of medical care you might need.

“We need benefits to make insurance meaningful,” said Dr. John S. Meigs Jr., president of the family physicians association. “I’m afraid if they get rid of the essential benefits, you’ll have meaningless insurance. Meaningless coverage.” He practices in Centreville, Alabama.

But Republicans say consumers should have a choice of the benefits they purchase, and the entire issue is best left to states and not the federal government.