Mother’s Day Menu from Congress and the American Health Care Act

This Mother’s Day, Congress is giving mothers a new health coverage menu with options for states and insurance companies to reduce their coverage through the American Health Care Act (AHCA). Highlights include:

MOTHER’S DAY AMERICAN HEALTH CARE ACT MENU:
Annotated Version

Appetizer
Choice of:
No Pregnancy Coverage or
Purchase a Separate Maternity Rider

The ACA guarantees all new health insurance plans offered on the individual market include maternity coverage as part of the essential health benefits package. This means any woman purchasing coverage on the individual health insurance market can buy a plan that will cover pregnancy related costs, including prenatal care, childbirth, and postnatal services. If AHCA passes the Senate and is signed into law, it will allow states to waive out of any or all of the essential health benefits package – including maternity coverage. So you can start your Mother’s Day celebration off with the possibility of losing health coverage for your next pregnancy or your daughter losing coverage for the birth of your expected grandchild.

Or you can pay thousands of dollars for a rider. The passage of AHCA will likely bring back maternity care riders, which were no longer needed after the ACA’s essential health benefits standard went into effect in 2014. For just a few thousand dollars a year, you will be able to obtain a rider that will cover some pregnancy related costs (maybe not prenatal care), have a high deductible that applies only to maternity services, or caps annual payments at about the same amount you pay in annual premiums.

If you want more cuts in benefits, don’t worry. Under AHCA a state is allowed to eliminate any or all of the essential health benefits. This means individual market plans may not have to cover mental health services, substance use services, or even prescription drugs. Insurance companies may let you buy expensive riders for these services too.*

*Riders include an additional fee

Entreé
Choice of:
Higher Premium Costs;
Higher Cost Sharing; or
Combination Platter of Both 

Don’t plan to become pregnant again? Don’t worry, because AHCA also promises higher premiums if you have a pre-existing condition, including any past pregnancy complications. The ACA ended the insurance practice of denying coverage to people with pre-existing conditions and charging higher premiums based on health status. Under AHCA, states can waive rating protections so that insurers can once again charge more to people with pre-existing conditions  if they have a gap of more than 62 days of continuous coverage. Even if you maintained continuous coverage, you’ll probably end up spending more for comprehensive coverage if your state chooses a waiver, because healthier people will gravitate towards less expensive, less comprehensive insurance options.

The amount of cost-sharing you pay for services is likely to rise under AHCA as well. If your income is under 250 percent of poverty and you receive coverage through the health insurance marketplaces, AHCA eliminates the cost sharing subsidies that provide you with a better health insurance plan. Your deductible, annual maximum, copays and coinsurance could increase significantly. If you have a higher income, you are still likely to see higher deductibles if you get covered through the individual market.

Dessert
Loss of Your Child’s Health Coverage

Just to make the meal sweeter, AHCA will not only put your health coverage at risk, but will also put your child’s health coverage at risk. If your child has Medicaid, you can expect that most states will need to cut back services or limit eligibility for the program in the wake of federal funding cuts (see more on this, below), with the most severe consequences if your child has a disability. If your state rolls back the essential health benefits requirement for private health insurance, you could see new annual or lifetime limits on your child’s benefits, even if you have employer-based coverage. If you have daughters or granddaughters, you can rest knowing they too will have less access to coverage for pregnancy related care. 

Sides
Defunding Planned Parenthood
No Tax Credits for Plans Covering Abortion
$839 Billion Cut from Medicaid

There are many other options for cutting access to health care services for mothers through AHCA. Defunding Planned Parenthood for one year will mean that mothers will lose access to family planning services, pap smears, and well-woman exams. Insurance plans on the individual market will likely stop covering abortion because tax credits under AHCA cannot be used for plans that cover abortion services – even though the tax credits under the ACA are not used to pay for abortion services. This is particularly special for women living in California and New York who may not be able to use the tax credits at all because all plans in their states currently cover abortion services. The biggest side dish is over $800 billion cut from Medicaid, with the inevitable result that moms will lose coverage, face service cuts, or higher costs for care. This side is large enough to share with your children who may also lose Medicaid coverage.

Special Course from Chef Trump
Loss of Contraceptive Coverage

AHCA doesn’t touch your birth control. But, President Trump has added to your Mother’s Day menu by signing an Executive Order, the same day AHCA passed the House, that directs federal agencies to consider amending regulations implementing the women’s preventive services requirements “to address conscience-based objections.” Secretary of Health and Human Services Tom Price quickly welcomed the opportunity to review taking away women’s access to contraception.

The executive order only targets women’s preventive services. Although the assumption is that the order targets contraceptive coverage in relation to several lawsuits claiming religious and moral objections to birth control, it is possible that there will be an attempt to amend other preventive services important to mothers. Coverage of many prenatal office visits, breastfeeding pumps, and lactation counseling are all part of the women’s preventive services targeted by the executive order.

 

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