Why 'essential benefits' are sticking point in Obamacare overhaul

Some house Republicans are seeking to peel back the provision.

ByMARYALICE PARKS
March 23, 2017, 6:22 PM

— -- Republicans are scrambling on Capitol Hill to rewrite their health care bill ahead of an anticipated vote on the measure, which could come as early as Friday morning after it was postponed today.

Some Conservatives want -– among other things –- language included in the law to scrap "Essential Health Care Benefits," a key provision in the Affordable Care Act, which mandated that all insurance plans sold on the individual marketplaces had to cover “essential” items, including:

- Ambulatory patient services

- Emergency services

- Hospitalization

- Pregnancy, maternity and newborn care

- Mental health and substance use disorder services, including behavioral health treatment

- Prescription drugs

- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

- Laboratory services

- Preventative and wellness services and chronic disease management

- Pediatric services, including oral and vision care

Free-market conservatives have long argued that these regulations are unfair to consumers and raise premiums. Their position is that insurance recipients -- like a young, healthy male -- shouldn't have to pay for a plan that includes coverage they don't need, like maternity care, particularly if it increases the cost of their plan.

“It's this potpourri of mandated benefits that everyone has to have. We've lost consumer choice,” White House press secretary Sean Spicer told reporters during his briefing today. “The idea is to instill choice back into the market.”

Spicer suggested that the White House was open to cutting these benefits, but said that everything was still up for negotiation.

Democrats –- and some Republicans –- argue that insurance economics work differently. They say insurance premiums often fall when more people buy into a pool, not just those who are sick or anticipating the need for coverage for a life event, like pregnancy. In their scenario, everyone chips in, and while only some people need services, everyone is covered just in case.

Before the ACA, consumers sometimes unintentionally bought so-called “junk plans” that did not provide basic benefits. Because those buying coverage on their own have little-to-no leverage, they can be susceptible to gimmicks or ploys from big carriers. Democrats argued these were important consumer protection regulations and would help drive down costs of better plans.

Democrats argue that a change to mandated benefits would not fly under Senate rules, which only permit budget-related tweaks for the measure to pass with 51 votes, as Republicans have been trying to do with this “repeal and replace” measure.

House Democratic Leader Nancy Pelosi told reporters she was very proud that her party included these benefits in the law they passed under president Obama.

“I'll just say that [cutting] essential health benefits means Republicans are making being a woman a preexisting condition again. Stripping guaranteed maternity care is a pregnancy tax pure and simple. Stripping guaranteed maternity care is a pregnancy tax pure and simple. Worsening the addiction epidemic and making it harder to access mental health care, making it more expensive to be sick in America,” she said.

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