The Republican health care bill—which dismantles the current Medicaid system while giving a massive tax cut to the super wealthy—may not have the votes necessary to pass the House. This would be an embarrassing outcome for Paul Ryan and the White House, so members of the Trump administration are working to drum up support for it. One way they're doing that, according to a report from Politico, is by working with the Freedom Caucus—basically the ideological nightmare wing of the already very conservative House—on a proposal to eliminate essential benefit requirements for all health care plans.
As it stands, the Affordable Care Act dictates that all insurance plans cover certain things to get to the market. If the reported revisions go through, the House bill would cut those requirements and leave it up to insurance companies to decide what to cover.
The services below are considered mandatory coverage under current law, as outlined on HealthCare.gov:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- 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
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
- Birth control coverage
- Breastfeeding coverage
The revisions could lead to a system in which an insurance company could sell you a plan that is coverage in name alone. That plan may be cheaper to purchase upfront, but if you need to fill a prescription or find yourself in the hospital, you're fucked. It's basically a return to catastrophic coverage as a norm.
The a la carte approach to insurance also collapses the basic foundation of our current health care system. Insurance works by pooling risks. I pay for insurance that covers medical issues that I may never personally experience with the knowledge that some health issues I may personally experience—like the slow death of having to read bullshit Republican health care proposals every day—would be covered. None of this works without unified risk pools.
Another provision that could be cut in the House bill, according to the Politico report, are protections for people with preexisting conditions:
Even with the White House agreement to remove essential health benefits, the Freedom Caucus members are continuing to push for more of the Obamacare regulations being pulled out of the bill before they agree to support the proposal, according to White House and congressional sources.
Freedom Caucus members, led by [North Carolina Representative Mark] Meadows, want at least some parts of Title One of the bill removed. Included in Title One are many of the Affordable Care Act's benefits, like a prohibition on insurers denying coverage over pre-existing conditions and a prohibition on lifetime and annual limits.
Together, these would compound the cruelty of a bill that already seeks to decimate affordable access to health care for people who are sick or low income (or even moderate income). And we already know what that looks like in the United States.
"My medications were coming to about $800 a month. It was too expensive," Elizabeth, a 35-year-old woman who went into debt after using her credit card to pay for her bipolar medication and doctor visits, told me last week when I asked her about managing a chronic illness without insurance. "It got to the point where I was doing just about every other day with my meds, which is a really bad idea. You just should not be doing that."
"When I was uninsured I found a lot of little ways to get by without medical care. I found myself making a lot of excuses to never go to the doctor," a 29-year-old woman with chronic asthma and depression told me. "If a tooth hurts or a cut looks infected, you just tell yourself it’ll probably be fine…. You just kind of hope you pull through it by yourself and that whatever you have doesn’t get even worse." She committed insurance fraud in order to get the inhalers she needed. She told me that being able to do that made her lucky.
People suffer and people die without adequate health care. They run up obscene levels of debt or they piece together inadequate care at free clinics and through ad hoc services. And if it works, if they can get the minimum of what they need or if the debt isn't so great that they lose their home, they call themselves lucky.
This Republican bill will already pull 24 million people off the insurance rolls within a decade. The provisions being debated right now will mean that those left with insurance may still end up with nothing at all.