Some Members of Congress are continuing to barrel ahead with their attempt to repeal the Affordable Care Act (ACA). Even after the non-partisan Congressional Budget Office estimated that the American Health Care Act – the budget reconciliation proposal to repeal the ACA – would result in 24 million people losing health insurance coverage. Just yesterday, the ACA Repeal Bill passed through another committee, setting the stage for a fight on the House floor next week. In their attempts to justify a bill that would be disastrous for individuals in this country, some Members of Congress and the Administration are resorting to a tired old trope – that repeal is needed because the law forces people to buy insurance coverage for things they don’t need. Specifically, forcing men to buy plans that include maternity coverage.
So in this week’s Worst Throwback Thursday Ever blog, we are going to unpack that ridiculous and offensive claim.
At the outset, it’s important to make clear that the ACA Repeal Bill does not target the provision of the ACA that requires maternity coverage in individual and small group plans. That’s not because those Members who are pushing repeal don’t think it should be repealed. It’s just because Members are trying to repeal the ACA through a process called budget reconciliation – which requires a simple majority instead of 60 votes to pass – and the Repeal Bill can only touch parts of the ACA that actually impact spending, revenues, or the federal debt limit. So instead, the ACA Repeal bill eliminates the requirement for people who gained coverage under the ACA’s Medicaid expansion, on the theory that because that includes federal funding, they can do it.
Indeed, comments from members of Congress and the Administration indicate that maternity coverage for all people may be on the chopping block in the future. For example, when pressed about their opposition to the ACA recently, White House press secretary Sean Spicer and House Republican John Shimkus (Illinois) – who sits on one of the House committees that approved the ACA Repeal Bill – both pointed to “men having to purchase” maternity coverage as “problems” with the law. And those in charge of implementing health policy in the Administration have also failed to support the required coverage of maternity. Tom Price, the new Secretary of Health and Human Services (HHS), refused to support the requirement during his confirmation hearing. Similarly, Seema Verma, newly confirmed Administrator of the Centers for Medicare and Medicaid Services (CMS), said that she does not necessarily support keeping maternity coverage as a requirement for insurance plans.
Comments like these make clear that ACA repeal and replace threatens to throw us back to a time when maternity coverage was nearly impossible to find, let alone afford. Moreover, having this conversation makes us think, haven’t we already settled this again and again?
Prior to the ACA, only 12% of individual plans covered maternity care, yet these same plans charged women more for coverage. This left women without the care they needed and saddled them with huge bills – hospitals charge an average of $32,093 for vaginal births and $51,125 for caesarian births covered by insurance. A woman who does not have coverage or whose insurance does not cover maternity could be billed the entire amount.
The ACA ended this discriminatory practice. The law requires insurance plans to cover a core set of important “essential health benefits,” like preventive services, prescription drugs, hospitalizations, and maternity and newborn care. The essential health benefits provision helps ensure that women can actually find and afford health coverage that meets their needs.
Politicians point to men and maternity coverage in effort to support their contention that people should be able to “pick and choose” among health services in insurance. Even ignoring the facts that men are essential to create children and that maternity coverage contributes to healthier women and children, and a healthier country overall – the idea that people should be able to pick which health services are included in their insurance plans illustrates a fundamental misunderstanding of the central principles of health insurance.
Insurance works by pooling risks. These risks include any kind of health care a person may need. As one health insurance expert has explained, “No individual is likely to need all of it, but we will all need some of it eventually.” We all pay for a variety of health services that many of us may never need, such as treatment for diabetes, heart attack, and high blood pressure (men are many more times more likely to suffer from all of these). And women and children even pay for services only men use such as prostate exams and Viagra. But that is how insurance works. If insurers begin allowing individuals to pick and choose which services to include in health insurance, then the risk pool falls apart and people that need these services can’t get them. This is exactly what we saw in maternity coverage prior to the ACA and this is exactly the problem the essential health benefits provision fixed – with little effect on the bottom-line cost of insurance premiums.
ACA repeal and replace threatens to throw us back to a time when women had nowhere to turn for maternity coverage. And comments criticizing the ACA’s maternity coverage requirement illustrate the danger of trusting people who don’t understand general health insurance principles and who apparently don’t believe in ending discrimination against women, to propose health policy that will affect the entire country.
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