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The U.S. Senate health care bill would allow states to waive federal requirements for what insurance plans must cover.
With state waivers, insurers could skip coverage of what the current Affordable Care Act now requires to be covered, known as essential health benefits like prescription drugs, laboratory services and hospitalization. Health insurance companies in those states would be able to sell lower-priced plans with less coverage. The House included the same provision in its Obamacare replacement bill, the American Health Care Act.
Rep. John Faso, a Hudson Valley Republican, defended the provision in a radio town hall before the Senate version was released.
"I read this provision extremely closely, and I don’t believe many, if any, governors will actually seek these waivers. It’s an extraordinarily limited waiver," Faso said. "It doesn’t apply to things like maternity coverage."
A spokesperson from Faso’s office said he was talking about how coverage for maternity care would still be required in New York state even if the state sought a waiver. Iinsurers are required to cover maternity care under New York state law, a distinction Faso did not make in his claim.
Is Faso right that the new waivers would not apply to coverage for maternity care?
Law on maternity care coverage
Maternity care is included in one of ten health care categories insurance plans have to cover under federal law.
Those categories, the essential health benefits, were established in 2010 as part of Obamacare. The benefits only apply to individual and group plans with 100 or fewer members, known as small group plans in New York state. Most states define small group plans as those with 50 or fewer members.
The House and Senate bills would allow states to waive the essential health benefits requirement. Insurers in those states would not have to cover any benefit not mandated by that state’s law.
"The waiver that was included in the American Health Care Act allows states to redefine essential health benefits as it applies to individual and small market groups in their state," said Matthew Fiedler, a fellow in the Center of Health Policy at the Brookings Institution, a nonprofit public policy organization.
"Maternity coverage is one thing that’s considered an essential health benefit today so a state could eliminate maternity care coverage in their state," Fiedler said.
Maternity coverage was not federally mandated before Obamacare. Only 18 states required it in small group and individual plans prior to the 2010 health care law according to the Kaiser Family Foundation, a health policy research organization.
Large group plans, those with more than 100 members in New York state, have been required to cover maternity care since the federal 1978 Pregnancy Discrimination Act.
Will could happen?
The Congressional Budget Office, a federal agency that provides nonpartisan fiscal analyses for Congress, predicted maternity care coverage would be lost in states that seek a waiver.
"Services or benefits likely to be excluded from the EHBs in some states include maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits," the agency said in a report on the American Health Care Act.
"If a state only waives the requirement that plans offer maternity coverage, then it’s unlikely any plan would voluntarily offer maternity coverage," said Cynthia Cox, associate director for health reform and private insurance at the Kaiser Family Foundation.
The CBO said maternity care may be offered by insurers in those states as a rider, or addition, to a plan. But that would not come cheap.
"Without maternity coverage, new moms could expect to pay about $17,000 out-of-pocket," Cox said. "Or, if they tried to buy a rider, they could expect to pay more than $1,000 per month."
Congress included $15 billion in the American Health Care Act for maternity care, mental health care, and substance use treatment. The CBO predicts that money will go to health care providers to reduce costs for patients instead of insurers.
Faso said a waiver in the American Health Care Act "doesn’t apply to things like maternity coverage."
The waiver applies specifically to maternity coverage. If a state does not require maternity coverage and is approved for a waiver, insurers there would not be required to cover maternity care.
We rate his claim False.
John Faso Radio Town Hall on Thunder 102, June 1, 2017
Email conversation with Dain Pascocello from Rep. John Faso’s office
Phone conversation with Matthew Fiedler, fellow in the Center of Health Policy at the Brookings Institution
Email conversation from Cynthia Cox, associate director for health reform and private insurance at the Kaiser Family Foundation
Analysis: Before ACA Benefits Rules, Care for Maternity, Mental Health, Substance Abuse Most Often Uncovered by Non-Group Health Plans, June 14, 2017, Kaiser Family Foundation
Pre-ACA State Maternity Coverage Mandates: Individual and Small Group Markets, Kaiser Family Foundation
The Pregnancy Discrimination Act of 1978, U.S. Equal Employment Opportunity Commission
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