A man holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare in Miami, Fla in 2015.
Photo by Joe Raedle/Getty

Overlooked part of GOP bill may undermine employer health plans

One of the goals of the Affordable Care Act was to avoid widespread disruptions to the existing system. Most Americans in the workforce have health coverage through their employers, and the ACA’s Democratic architects made sure not to undermine those plans.

On the contrary, “Obamacare” did the opposite, leaving that coverage untouched, except to add consumer protections such as a ban on lifetime limits.

With that in mind, many Americans may be watching the Republican health care crusade with a degree of emotional detachment: the GOP bill may be indefensible, many are likely thinking, but it won’t affect me personally because I have coverage through my private employer.

The Wall Street Journal reports today, however, on a provision of the Republican legislation that could affect those who thought they were safe from the GOP’s bill.
Many people who obtain health insurance through their employers – about half of the country – could be at risk of losing protections that limit out-of-pocket costs for catastrophic illnesses, due to a little-noticed provision of the House Republican health-care bill to be considered Thursday, health-policy experts say.

The provision, part of a last-minute amendment, lets states obtain waivers from certain Affordable Care Act insurance regulations. Insurers in states that obtain the waivers could be freed from a regulation mandating that they cover 10 particular types of health services, among them maternity care, prescription drugs, mental health treatment and hospitalization.

That could also affect plans offered by large employers, health analysts said.
When implementing the ACA, the Obama administration said employers could choose any state’s requirements for health benefits, because it didn’t make a practical difference: the law mandated certain benefits for the nation, establishing a floor that no state could fall below.

The Wall Street Journal’s report, however, notes that the Republican plan would empower states to establish new and lower benefits benchmarks – which would open the door to employers everywhere choosing to follow the standards of the state with the worst standards.

“By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation,” the article explained.

Andy Slavitt, who ran the Centers for Medicare and Medicaid Services in the Obama administration, told the WSJ this provision is “huge,” adding that Republicans are “creating a backdoor way to gut employer plans, too.”

To be sure, there’s a lot we don’t know in a situation like this. It’s unclear how many states would take advantage of the opportunity to create weaker standards, how low those states would go, and how many employers would exploit this option.

The point, however, is that under the Affordable Care Act – the law of the land, as it currently exists – the protections for Americans are already in place. Under the GOP’s American Health Care Act, those protections would disappear, with untold consequences for an unpredictable number of people, including you.

This is precisely the sort of detail that would’ve come to light much sooner if Republicans were following the American legislative process. In fact, this may not even be the intended goal of the GOP policy. But because the Republican-led House is scrambling to pass a bill without scrutiny or serious consideration, messy policy implications are inevitable.

This is clearly one of them.

Health Care and Health Care Policy

Overlooked part of GOP bill may undermine employer health plans