White House press secretary Sean Spicer on Thursday defended the idea of taking away guaranteed maternity coverage in health insurance, denying that it would mean women must pay relatively more for their health care.
He’s wrong about that. Ending the guarantee could mean slightly lower premiums for individual men and much older women, but it would just as surely drive up premiums for women of child-bearing age and their families ― unless it left them paying the full cost of prenatal care and delivery, typically many thousands of dollars, out of their own pockets.
It’s yet another case of Republicans trying to disguise the very real trade-offs of their effort to repeal the Affordable Care Act.
The issue of maternity benefits began to get a lot of attention on Wednesday night, as word spread of a deal that the White House and GOP leaders were making with conservative House Republicans, in a desperate effort to rally the votes they need to win approval there for the American Health Care Act.
Conservatives have been holding back support, because, they say, the repeal bill leaves too much of “Obamacare” intact. And a big focus of their anger has been the law’s regulations on what insurance covers ― which, by and large, the original version of repeal legislation left intact.
In the course of negotiations, the White House and GOP leaders agreed to revise the bill, so that it repeals a set of rules requiring that all insurance plans cover a set of 10 “essential health benefits.” One of those benefits is coverage for maternity care.
The Affordable Care Act mandates maternity coverage because, in the old days, insurance frequently didn’t offer it ― or did so only if beneficiaries were willing to pay a hefty surcharge. Today, all policies include maternity, along with coverage of mental health care, habilitative care, and prescriptions ― three benefits that, previously, insurers frequently did not.
These mandates came with a cost. Including these benefits has forced insurance companies to pick up medical expenses they were able to avoid previously, and as a result they have raised premiums to cover their new costs ― a point that Spicer, during his daily White House briefing, made correctly.
But a reporter asked Spicer the natural follow-up: If eliminating maternity coverage will reduce premiums overall, won’t it also mean higher costs for people who actually need the care?
And wouldn’t it be the same for other essential benefits ― slightly lower premiums for all, but much higher out-of-pocket costs for the people who might need some of those other essential services?
The correct answer would have been “yes.” Here is how the exchange went instead:
Q: Is the president concerned that without having those essential benefits in there, you’ll have a situation where women are just de facto paying higher for health insurance. Obviously they’d be paying for maternity leave ―
SPICER: No, you could have a family plan. Again, you’re picking one benefit and trying to extrapolate it. It’s also saying should young people pay for end-of-life care? The idea is to instill choice back into the market. It’s not just about one particular benefit. It’s allowing people to tailor a plan and cost point that’s good for them and their family or them and their spouse.
It’s not entirely clear what Spicer means by a “family” plan. A plan for the whole family, rather than an individual? One that includes maternity coverage as a special addition?
Either way, absent a guarantee of maternity coverage, most insurers will not offer it or charge extra for it ― which, in either case, means the people who want it would have to pay more.
The second part of the answer gets closer to the heart of the issue, which is really the fundamental debate taking place right now. To what extent should the cost of health care fall on those individuals and families who need it, because they have health problems, and to what extent should government require insurers to spread that financial burden as broadly as possible?
But the trade-offs here are different than Republicans typically let on. The price for allowing everybody to save a few dollars a month on premiums is forcing thousands, tens of thousands, or even hundreds of thousands of dollars in medical bills onto those with illnesses that insurance doesn’t cover.
As for the idea that removing regulations will allow people to “tailor” benefits to their liking, that overlooks the fact that people frequently have no idea what medical problems they will have in the future ― and that, in an unregulated insurance market, even insurers that want to cover services like mental health or maternity would find it too costly, because doing so would attract disproportionate numbers of people who need the coverage.
In other words, people who wanted or needed those benefits would be unable to find them.
And if the American Health Care Act were to become law, coverage could end up even worse than it was before Obamacare, because Republicans have said they would keep in place the law’s popular guarantee of coverage for people with pre-existing conditions.
Unable to avoid such customers, insurers would have even more incentive to avoid providing expensive benefits ― to the point that they might start cutting out services pretty much everybody takes for granted.
The only safeguard against this would be new state regulations. But in the past, many states had thin regulations ― and if somehow Republicans were able to both allow and encourage cross-state insurance purchases, even states trying to regulate their markets might be unable to do so.
David Anderson, who until recently was an analyst at the UPMC Health Plan in Pennsylvania and is now an analyst at Duke University’s Margolis Center for Health Policy, thinks the end result in unregulated states could be deeply bifurcated markets ― with comprehensive, traditional coverage available only at extremely high prices that few could afford, and cheap policies with bare-bones benefits that barely qualify as insurance.
Such policies, he explained at the blog Balloon Juice on Thursday, would have tiny, narrow networks of doctors and hospitals, $20,000 deductibles, and maybe no coverage for things like asthma inhalers, Epi-Pens and insulin.
“Their benefits will be designed to drive away sick people with chronic conditions … the population that will choose these policies will have to be very healthy,” Anderson wrote.