Sherry Glied, Dean of New York University’s Robert F Wagner Graduate School of Public Service, and former assistant secretary for planning and evaluation at the Department of Health and Human Services, explains how the Senate healthcare bill will affect people who get insurance from their employer. Following is a transcript of the video.
SHERRY GLIED: The bill doesn’t directly affect the coverage of people in their jobs, but it does do that indirectly, in one particular way.
The bill would allow states to get waivers to change the benefits that are required under the essential health benefits which is a requirement in the Affordable Care Act that says all plans must cover these 10 categories of benefits.
Hospital care, prescription drugs, physician care, mental health and substance use care, pediatric care and so on — maternity care. There has been a lot of concern that some people might not want or need those benefits and they ought to be able to be able to buy plans that exclude the benefits.
And that’s what these waiver provisions would allow states to do. To say, you’re allowed to sell a plan that doesn’t include mental health or substance use benefits. You’re allowed to sell a plan that doesn’t include maternity benefits.
Now, why does that matter for people with employer coverage? In general, the essential benefits don’t affect them. But, they do with respect to one important provision.
The Affordable Care Act says that you can’t have a lifetime or annual limit on services that are included in the essential benefits. So, by allowing states to change those essential benefits, they could really shrink what is covered under the restriction on lifetime and annual limits on employer coverage.
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