Health Care Bill Debate Centered On Essential Health Benefits

NPR's Audie Cornish talks with Noam Levey, who covers national health care policy for The Los Angeles Times, about why essential health benefits became such a sticking point in the health care debate.

KELLY MCEVERS, HOST:

In the coming days, there will be lots of digging into what brought down the Republican health care bill. Here's what House Speaker Paul Ryan had to say just after the vote was called off.

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PAUL RYAN: I will not sugarcoat this. This is a disappointing day for us. Doing big things is hard. All of us - all of us, myself included - we will need time to reflect on how we got to this moment, what we could have done to do it better. But ultimately, this all kind of comes down to a choice. Are all of us willing to give a little to get something done? Are we willing to say yes to the good, to the very good, even if it's not the perfect? Because if we're willing to do that, we still have such an incredible opportunity in front of us. There remains so much that we can do to help improve people's lives. And we will.

MCEVERS: That's House Speaker Paul Ryan earlier today. Over the past few days, something referred to as, quote, "essential health benefits" became one of the biggest sticking points in the health care debate. And these are 10 categories of services that insurers must cover under the Affordable Care Act, also known as Obamacare. They're things like maternity care, pediatric care, lab services, hospitalization.

Members of the conservative Freedom Caucus wanted the Republican bill to remove the requirement that insurers cover essential health benefits. In the final bill, it looked like states would have the power to define what is essential. But that was not enough for the Freedom Caucus members to vote for the bill.

AUDIE CORNISH, HOST:

For more now on why it became a big issue, we're joined by Noam Levey. He covers healthcare policy for the LA Times. Hi there, Noam.

NOAM LEVEY: Hi there. Good to be with you.

CORNISH: So is this something that people are going to look back and say essential health benefits helped kill the Republican health care proposal?

LEVEY: I think they will. I mean, there are any number of reasons why Speaker Paul Ryan couldn't get the votes. But this provision in the end proved to be something that was too popular to kill, and yet too controversial for conservative Republicans to abide.

CORNISH: And we should say that this is a provision that essentially says no matter what you offer, it's got to have these things in it, even at your cheapest level.

LEVEY: That's right. And the reason it was put into the law to begin with was a feeling by the architects of the Affordable Care Act that too many Americans were getting stuck with health insurance plans that didn't cover the kinds of benefits that they needed.

And so this a few years ago put a requirement on health insurers to cover these basic set of benefits. Republicans argued for years that this was one of the reasons why health plans were not more affordable. And that's one of the reasons why the House Freedom Caucus demanded that it be removed from anything that the House passed.

CORNISH: Now, you've been talking to people all over the country. Do people use the so-called essential health benefits? Were they actually talking about being afraid of losing them?

LEVEY: They were. And, you know, the big benefit in Obamacare that's gotten the most attention over the years is the guarantee issue, the idea that you can get health insurance even if you are sick. This one didn't get a lot of attention in part because people didn't realize how important it was until they went to go use some of these services. This was particularly important for people dealing with mental health issues and substance abuse issues.

We've obviously heard a lot over the last few years about the opioid epidemic. And one of the things which I have certainly heard talking to people around the country was how grateful they were that those benefits were available for sicknesses that many people didn't appreciate.

And so when people needed to go see a mental health counselor or get a crisis because of a drug addiction dealt with, health plans could provide that. So this became sort of a rallying point in the last 24 to 48 hours for a lot of patient groups and other consumer advocates who came out very strongly against what the House was trying to do.

CORNISH: Noam Levey covers national health policy for the LA Times. Thank you so much for speaking with us.

LEVEY: My pleasure.

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