Will insurers drop maternity coverage if the AHCA passes?
Maternity, substance abuse and mental health treatment least covered before health reform
A key piece of the American Health Care Act, the GOP plan to repeal and replace Obamacare, would allow states to waive the regulation that requires insurers to cover ten “essential health benefits.”
The Affordable Care Act required all individual plans to cover ten “EHBs.” These are services like hospitalizations, prescriptions, maternity and pediatric care, among others.
In order to reduce premium prices, the AHCA would allow individual states to decide whether to keep this regulation or waive it. In other words, plans in states that waive the EHBs would be “skinnier,” or cover less, than plans in states that uphold the EHBs.
But what does this mean for consumers? Would insurers stop covering these ten services if the state does not require them to?
Some services covered
According to a study by the Kaiser Family Foundation, some services would likely still be covered. The KFF compared more than 8,000 individual plans offered in 2013, the most recent year before the ACA went into effect, to see what plans covered.
Most plans covered several of the “EHBs” already—all or virtually all of the plans covered hospital services, surgical services, emergency care, primary care and imaging.
Maternity, mental health coverage at risk
But mental healthcare, substance abuse treatment and maternity care were all less likely to be covered before the ACA required them to be.
In particular, 75 percent of individual health plans did not cover maternity care before the ACA. Thirty-eight percent of plans did not cover mental healthcare, and 45 percent did not cover substance abuse treatment.
The study issued a warning—“If states were to drop any of these services from the list of essential health benefits for non-group plans, access to them could be significantly reduced.”
Why cut EHBs?
Why does the AHCA want to allow states to waive this regulation? Requiring all individual plans to cover a wider range of services has led to increased premium prices. Before the ACA, insurers could simply not cover these services, or deny coverage to people who already needed them. This resulted in fewer expenses for the insurer and lower premiums for the consumer.
Requiring the insurer to cover these services for anyone who needs them means increased claims for the carrier, which has been passed onto the consumer.
Policymakers are in the challenging position of balancing lower costs for people who don’t need these services and protecting access to coverage for consumers who do.
One possible outcome if states are allowed to waive EHBs is that consumers may congregate in states with more robust coverage. For example, if Kansas waived the EHBs but neighboring Colorado did not, consumers might move across state likes when they planned to get pregnant or seek substance abuse treatment.
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