These Are the “Essential Benefits” on the AHCA Chopping Block

Today marks the seventh anniversary of the Affordable Care Act, and Republican leaders in the House of Representatives are gunning to push their proposed replacement, the American Health Care Act, on this birthday.

In response to some conservatives rejecting the AHCA as “Obamacare Lite,” GOP leaders are proposing the removal of Obamacare’s “10 Essential Benefits” — which is the list of things that all Obamacare health insurance policies must cover.

What would this potentially mean for you and your family? Here are those “essential benefits” that would be stripped away:

  1. Pediatric services — Including dental and vision care for children.
  2. Pregnancy, maternity and newborn care — Some argue men shouldn’t pay for a service they’ll never use, while David Cutler, a Harvard University economics professor who helped design the Affordable Care Act, rightfully points out: “It is true that women get pregnant but men kind of help them get pregnant.” Um, yeah, kind of. Pre-ACA, a whopping 62 percent of people with non-group policies had no maternity benefit.
  3. Outpatient care — This covers most scheduled doctor visits, such as to check a rash, or a non-emergency ear infection. Insurance companies negotiate deals for these and often designate “networks” of doctors and clinics with approved charges. Individuals who walk in without coverage pay much, much more.
  4. Emergency room trips — Insurance policies cover both the ER visit and ambulance trips. Otherwise people can get socked with bills totaling tens of thousands of dollars, perhaps incurred while they were unconscious or busy tending to their toddler who just got 6 stitches in his tiny forehead after running into a doorknob (not that I’d know anything about that… *ahem*).
  5. In-hospital care — All care people get as hospital patients, such as surgery or a child’s tonsillectomy. Some conservatives argue that people should be able to choose to opt out of this type of coverage and pay lower premiums. Most health policy experts say this is a gamble. “One answer is because someday you may be sick and that’s the way that insurance works,” says Cutler.
  6. Mental health and substance abuse disorder services — This particular benefit has gotten some attention with the ongoing opioid epidemic. In America, a baby is born dependent on opioids every 19 minutes and newborns are dying after being sent home with moms who are addicted and neglectful. They clearly need help.
  7. Prescription drugs — Insurance companies usually negotiate discounts. Out-of-pocket costs for many drugs can be much higher than what an insurer pays for them.
  8. Rehabilitative services and habilitative services. These include help recovering from an injury or illness, but also treatment for kids with autism or cerebral palsy.
  9. Lab tests
  10. Preventive services — This includes vaccines, cancer screenings such as mammograms and colonoscopies and — believe it or not — coverage of birth control.

One potential road block in removing the essential benefits: today’s vote on the AHCA comes under congressional rules that say any bill must affect the budget. Meaning: any changes to the essential benefits requirements will have to lower federal spending somehow. And Larry Levitt of the nonpartisan Kaiser Family Foundation said that’s unlikely, Tweeting, “It’s almost certainly the case that repealing benefit requirements would raise the cost of the AHCA since more people would use tax credits.”

So, yeah, gutting these benefits would cost Americans even more money.

To urge your representatives to block the ACA repeal plan and save these essential benefits, find his/her contact information  and call ’em at 5Calls.Org.


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