One of the most important aspects of the ACA is the 10 essential health care benefits. This added specific criteria of what insurance must cover in their policies.What are the 10-essential benefits insurance must cover? Healthcare.gov (2017) lists them as:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital
- Emergency services
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
I feel like a lot of people don’t really understand how health insurance works (or why companies would not want to cover these 10 things); I had no idea before I took an introduction to public health policy. To sum up private health insurance (very basically): all eligible individuals are placed into a risk pool and each one pays a monthly premium to spread the risk/cost around. These monthly payments pay will cover the costs for health services for sick or injured individuals in the pool.
For example: If you have a risk pool of 100 people and each person pays $100 per month, insurance has $10,000-dollar revenue. But let’s say 10 people in the pool get sick and their care ends up being $15,000 that month, the insurance then is at a loss of $5,000. Insurance is a business and therefore the goal is to make a profit. The company makes more money when their risk pools are comprised of healthy individuals. This is why insurers used to deny coverage or charge more to individuals with pre-existing conditions.
A preexisting condition is “a health problem you had before the date that new coverage starts” (HHS, 2017). Things like cancer, HIV, pregnancy, Alzheimer’s, acne, mental illness, domestic violence and rape victims, etc. fall into this category. When I found out that people could be denied coverage (and the things which counted as a pre-existing condition) I was stunned. It seemed so wrong and unethical. How could we as a nation leave so many people exposed to huge finical and health risks? People who were already incredibly vulnerable.
The 10 essential health care benefits also require maternity care coverage. Prior to the ACA very few women had maternity coverage. An uncomplicated birth could cost already insured women $10,000 and uninsured women $30,000 (THA 2013). Some Republican politicians do not think men should have to pay for prenatal care, as ‘a man has never delivered a baby’ (Woodall, 2017). I learned in my policy class that every dollar spent in family planning has a 400% return. How is it not in our best interest (morally and economically) to provide this coverage?
Women’s health care protections are especially in danger; just this Friday some protections on birth control coverage were removed from health insurance policies. This allows a company or non-profit to remove contraceptives from their coverage due to religious or moral objections (Kodjak, 2017).
There is an ongoing debate about healthcare in the US. The current administration wants to ‘replace and repeal’ the ACA. The 10 essential health care benefits are in danger, all the proposed replacements have severely weakened or removed them. The US is one of the only developed countries who does not have universal health coverage. These policies largely stem from the belief that healthcare is a privilege, not a right.
Kodjak, A., (2017). Trump Guts Requirement that Employer Health Plans Pay for Birth Control. Retrieved from http://www.npr.org/sections/health-shots/2017/10/06/555970210/trump-ends-requirement-that-employer-health-plans-pay-for-birth-control
Healthcare.gov. (2017). What Marketplace health insurance plans cover. Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
Health and Human Services. (2017). Pre-existing conditions. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html
Woodall, C., (2017) GOP Congressman asks why men should pay for prenatal care. Retrieved from http://www.pennlive.com/news/2017/03/gop_congressman_asks_why_men_s.html
Truven Health Analytics. (2013). The Cost of Having a Baby in the United States. Retrieved from http://transform.childbirthconnection.org/wp-content/uploads/2013/01/Cost-of-Having-a-Baby1.pdf