Essential benefits could change

Thursday’s vote to repeal the Affordable Care Act means people who get health insurance through their employers could wind up with lifetime limits on their coverage and plans that don’t cover benefits such as mental health or maternity care, just as it would be for those who buy their own insurance on the ACA exchanges.

The ACA prohibited annual and lifetime limits on coverage, just as it established a set of essential benefits that all insurance plans must cover. Those include preventive care, such as mammograms, as well as benefits for hospitalization and substance use disorder.

Provisions in the replacement legislation, the American Health Care Act, don’t specifically mention employer-provided “essential health benefits,” but Brookings Institution fellow Matthew Fiedler says it could have a big effect on those who get insurance through their jobs. Once states can determine what benefits insurance plans must cover, large employers could move to slash coverage based on whatever states set as a benchmark plan.

The two major affected protections are the ACA’s ban on annual and lifetime limits and the law’s requirement that insurance plans cap people’s annual out-ofpocket spending.

“Both of these provisions aim to ensure that seriously ill people can access needed health care services while continuing to meet their other financial needs,” Fiedler wrote.

It’s not clear at all whether insurers would offer optional maternity coverage at an affordable price, says the Kaiser Family Foundation’s Larry Levitt. Women past childbearing age often complained about high premiums on plans they said covered things like maternity care they didn’t need.