Allowing states to define essential health benefits could weaken ACA protections-ACROSS THE BOARD!

[Snarkoleptic]

Call your Senators, they're coming for your employer-based coverage too!!

https://www.brookings.edu/2017/05/02/allowing-states-to-define-essential-health-benefits-could-weaken-aca-protections-against-catastrophic-costs-for-people-with-employer-coverage-nationwide/

In particular, a single state’s decision to weaken or eliminate its essential health benefit standards could weaken or effectively eliminate the ACA’s guarantee of protection against catastrophic costs for people with coverage through large employer plans in every state. [1] The two affected protections are the ACA’s ban on annual and lifetime limits, as well as the ACA’s requirement that insurance plans cap enrollees’ annual out-of-pocket spending. Both of these provisions aim to ensure that seriously ill people can access needed health care services while continuing to meet their other financial needs.

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In particular, a single state’s decision to weaken or eliminate its essential health benefit standards could weaken or effectively eliminate the ACA’s guarantee of protection against catastrophic costs for people with coverage through large employer plans in every state. [1] The two affected protections are the ACA’s ban on annual and lifetime limits, as well as the ACA’s requirement that insurance plans cap enrollees’ annual out-of-pocket spending. Both of these provisions aim to ensure that seriously ill people can access needed health care services while continuing to meet their other financial needs.

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Under current law, allowing large employer plans this type of flexibility has limited impact since all states’ essential health benefit definitions are required to meet basic federal standards. But if each state could set its own definition of essential health benefits, as states would be allowed to do under the MacArthur Amendment, the consequences of allowing this flexibility would be significant.

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Suppose that even one state secured a waiver that allowed it to drop maternity services, mental health services, or prescription drugs from the definition of essential health benefits—a plausible scenario since these services were
commonly not covered in individual market plans prior to the ACA and since waivers would be easy to obtain. In this case, a large employer plan that wanted to impose an annual or lifetime on limit on these services could simply adopt that state’s definition of essential health benefits. Likewise, a large employer plan that did not want to limit enrollees’ out-of-pocket spending with respect to these services could also take this approach. In a more extreme, but still plausible, scenario in which even one state elected to completely eliminate its essential health benefit standards, the requirement to provide these protections would effectively disappear entirely for large employer plans nationwide.

[dawg]

1. Of course it would.

My state (Georgia) would probably define essential benefits as "walk it off".

[Snarkoleptic]

2. and even though the bill is the worst one yet,

R's have said without gutting healthcare, they would have little chance of getting their real prize... tax cuts for the rich.

[dawg]

3. They could pass tax cuts without an ACA repeal.

The ACA repeal is just a chance for them to double-dip on tax cuts.

If they aren't careful, all the time they spend dicking around with this issue will distract them from their real prize, and before they know it it'll be January and they still won't have a tax bill.

[spanone]

4. kiss pre-existing condition guarantees away

it would be up to the states....gone