Possible repeal of required health benefits draws ire of public hospitals, ER docs

In last-minute negotiations on the American Health Care Act (AHCA), eliminating the 10 “essential health benefits” requirements put in place by the Affordable Care Act (ACA) was floated as an option to win over conservative lawmakers, a shift in policy which was quickly opposed by groups representing public hospitals and emergency physicians.

The 10 benefits, or EHBs, are services which the ACA required insurers to cover: outpatient care, emergency services, hospitalization, maternity care, mental health, prescription drugs, rehabilitation, laboratory services, preventive care and pediatric services.

Previously, that provision of the ACA was considered untouchable under the AHCA, which was introduced as “budget reconciliation” legislation, meaning it can only deal with items which affect the federal budget while avoiding a potential filibuster in the Senate. Republicans changed course on March 22, with Utah Sen. Mike Lee telling the Washington Examiner he now believes it could be included, and the Associated Press reporting the White House was open to stripping those benefits through the bill.

If those benefits were eliminated, insurers could once again offer less expensive plans which cover fewer services. It could potentially create the very “death spiral” insurance market Republicans claim the ACA is currently experiencing (and which the Brookings Institution said is false) by encouraging younger, healthier customers to buy skimpier coverage while more comprehensive plans are only purchased by higher utilizers.

America’s Essential Hospitals, a coalition of public hospitals, was already opposed to the AHCA due to its deep cuts to Medicaid, but said repealing benefits like preventive care “would make this damaging bill even worse.”

“It could leave countless people with too little coverage to meet their health care needs and drive higher rates of uncompensated care at hospitals already struggling to cover their costs,” said the group’s president and CEO Bruce Siegel, MD, MPH. “Americans deserve better than a future where they could be denied basic health care services. House lawmakers must reject this bill and work with hospitals and other stakeholders on reform measures that ensure access to comprehensive, affordable coverage for all who have it now.”

The American College of Emergency Physicians hasn’t formally opposed the bill but tweeted “that could change” if essential benefits, including emergency care, were no longer required. It pointed to a recent survey which said 95 percent of patients want insurers to cover emergency room visits, adding “so do we.”