How Will The AHCA Affect Me If I Have Coverage Through My Employer? It's Complicated

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On Thursday, May 4, mere months after it was first proposed, and without an updated score from the Congressional Budget Office, Republicans in the House of Representatives passed the American Health Care Act. The bill's passage has stirred an immense amount of fear and concern, given what it would mean for Americans with pre-existing health conditions, what it would do to their premiums, and what would happen to millions of people who'd lose their coverage as a result. So, you might be wondering: how will the AHCA affect people with employer coverage?

According to a recent report in The Wall Street Journal by Stephanie Armour and Michelle Hackman, there's good reason to think the bill that could end up being a huge problem for people who get their health insurance through their jobs. It's not an explicitly stated goal of the bill, to be clear, but one of the major regulatory changes in the bill could potentially destroy minimum coverage standards for some employee plans.

Here's the basic idea: one of the key reforms in the Affordable Care Act, popularly known as Obamacare, was the mandating of ten "essential health benefits" which insurers have to cover, even in their most basic, bare-bones plans. They include maternity care, outpatient care, doctor's visits, prescription drugs, mental health services, hospital visits, physical rehabilitation, lab testing, and pediatric care. Sounds sensible enough, right?

But there's a loophole involved, and while it looked unimportant and meaningless when the Obama administration was calling the shots, it could end up having a devastating impact if the GOP passes the AHCA. That's because Obamacare actually allows employers to adopt any state's definition of minimum coverage for their plans. That's not a problem, as long as those ten minimum essential health benefits are a national requirement.

But if the AHCA passes, individual states will be empowered to get waivers allowing them to strip Obamacare's essential health benefits. And if that happens, employers could then use those individual state definitions of minimum coverage to drastically slash what their plans have to cover.

Imagine, for example, that Utah decides its essential health benefits won't include mental health services anymore. Then, your employer exercises its power to apply Utah's minimum standards to its plans, even though you don't live in Utah. Suddenly, your mental health is now longer covered.

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It's just one more potentially dire consequence of the GOP's massively unpopular health care bill. Considering that it would also allow states to get waivers allowing insurers to jack up rates on people with pre-existing conditions ― health insurance you can't afford is no insurance at all, needless to say ― it's not hard to see why so many people are literally terrified with every step the bill takes towards passage.

There's no guarantee that these provisions will still exist by the time the bill is voted on by the U.S. Senate, however. Republican leaders in the Senate have already signaled that they plan to start over and write their own health care bill, then kick that back to the House and force them to make an up-or-down call. As such, it possible that this potentially devastating employer coverage loophole could be patched up, but there's simply no way to know for sure until the Senate produces a bill of its own.