House Freedom Caucus, which does not back current plan, wants to remove 10 ‘essential health benefits’ guaranteed by Affordable Care Act health insurances

The Affordable Care Act’s guarantee of maternity benefits in the insurance marketplace appears in doubt after a group of hardline conservatives demanded that the Republican repeal plan do away with mandated essential benefits.

Reports on Thursday morning said the House Freedom Caucus, which has resisted throwing its support behind the Republican leadership’s plan to repeal the ACA, demanded that the bill scrap a list of 10 “essential health benefits” for all individual and small business insurance plans, which includes prenatal, maternity and newborn care.

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With the essential health benefits in jeopardy, so is House speaker Paul Ryan’s promise that the Republican replacement for Obamacare would not result in women being charged more for healthcare than men.

“Our proposal specifically prohibits any gender discrimination,” reads the website devoted to explaining the bill. “Women will have equal access to the same affordable, quality healthcare options as men do under our proposal.”

Conservatives say they oppose the essential health benefits because it limits the diversity of plans available for consumers to choose on the market.

Vice President Pence (@VP) Appreciated joining @POTUS for meeting with the Freedom Caucus again today. This is it. #PassTheBill pic.twitter.com/XG6lQIy5a6

Before Obamacare, insurance companies in most states offered two plans, one without prenatal and maternity benefits, and one plan with those benefits that charged much higher premiums. Only 38% of people in the individual markets had a plan with maternity coverage.

A repeal of the essential benefits would allow insurance carriers to once again sell two separate plans, with premiums up to 70% higher for women purchasing maternity coverage, according to one independent analysis by the actuarial firm Milliman. Women, they estimate, could face out-of-pocket costs of around $15,000 if they were to become pregnant and give birth without coverage.

“What life was like before we had the mandate is probably a pretty good predictor of what would happen without it,” said Alina Salganicoff, the vice-president for women’s health policy at Kaiser Family Foundation, a healthcare policy non-profit. “Women who wanted to have maternity care typically had to purchase it long before getting pregnant. And if you found yourself pregnant without that coverage, you were basically uninsured for all your pregnancy-related care.”

Women in some states might qualify for public assistance or could give birth at public hospitals. But many would simply be forced to pay their own way. “Without a doubt, many women would be bearing high out-of-pocket costs.”



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Salganicoff ticked off the list of arguments for preserving mandatory coverage of pregnancies: men are fathers; men contribute to pregnancy; healthy pregnancies and babies are a value. The cost is low per person if everyone pays for the coverage – $8 to $14 a month, according to Milliman – but the cost skyrockets if it is only shouldered by pregnant women.



“It’s antithetical to the way insurance works,” she added. “The principal is, everybody puts in for whatever may happen to a member of the group. I’m not going to say, as a woman, I’m not going to buy this insurance because there’s an older man in my pool who might get prostate cancer. There’s no guarantee you’re going to get any of the conditions that are covered. That’s the nature of insurance.”

A repeal of the essential health benefits could face obstacles in the Senate. Republicans are pushing their plan under rules that prevent a filibuster, so long as all the bill’s provisions pertain to government spending. It is unclear if essential health benefits would be ruled as relating to government spending.