Mind and Destiny

“I make no pretension to patriotism. So long as my voice can be heard ... I will hold up America to the lightning scorn of moral indignation. In doing this, I shall feel myself discharging the duty of a true patriot; for he is a lover of his country who rebukes and does not excuse its sins. It is righteousness that exalteth a nation while sin is a reproach to any people.”- Frederick Douglass

Location: Delhi, N.Y., United States

The author and his webmaster, summer of 1965.

Saturday, April 01, 2017

Essential Health Benefits

Before the Patient Protection and Affordable Health Care Act, 62 percent of the people in the insurance market had plans that didn’t cover maternity care.  Furthermore, 34 percent had plans that didn’t cover substance use treatment; 18 percent had plans that didn’t cover mental health; and 9 percent had plans that didn’t cover prescription drugs.

Reportedly, the White House and House Republican leaders negotiated with House Freedom Caucus members to eliminate federal minimum benefit (“Essential Health Benefits”) standards for individual and small-group market plans.  Had the House Freedom Caucus prevailed in those negotiation people with pre-existing conditions would have been unable to find the coverage, and women would have been charged more than men.

Eliminating the “Essential Health Benefits” would have allow insurers to discourage enrollment of people with costly healthcare need, by cutting covered health services and raising out-of-pocket costs.  Insurers would restructure the benefits to entice healthy people to enroll, but bypass those with pre-existing conditions.

Currently, federal minimum standards require that individual and small-group health plans cover: emergency services; hospitalizations; outpatient care; maternity and newborn care; mental health and substance use disorder treatment; prescription drugs; rehabilitation services; laboratory services; preventive services and chronic disease management; and pediatric care.  

Without Essential Health Benefit standards, many insurers would most likely stop covering pre-existing conditions by discouraging enrollment of sicker, more costly enrollees.  Eliminating Essential Health Benefit requirements would mean that women would be charged more than men, since they’d have to pay more for plans with maternity coverage.

Before the ACA, millions of people had health insurance that wouldn’t actually cover them if they got sick.  The ACA  prohibited annual and lifetime limits and set an annual limit on what enrollees could be required to pay in out-of-pocket for deductibles. 


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