Cheers–and Boos–If ACA Required Benefits Get the Ax


The Trump administration’s plan to place more power in states’ hands regarding what needs to be covered and what doesn’t falls as a blessing for some, a curse for others. The ACA says that plans sold to individuals and small businesses must cover 10 essential benefits:

  • ambulatory patient services
  • emergency services
  • hospitalization
  • maternity and newborn care
  • mental health and substance use disorder services, including behavioral health treatment
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • laboratory services
  • preventive and wellness services and chronic disease management
  • pediatric services, including oral and vision care

The coverage mandates were meant to protect consumers, with the minimum standards ensuring that there would be no gaps in coverage, but they also helped make individual insurance coverage more expensive.

The mandate also fueled insurers’ concern about how to control the costs of benefit packages. The Wall Street Journal looked at how the easing of those mandates affects individuals.

Small business owner Tom Skahill didn’t pay for maternity or mental health benefits before the ACA. Now, he must. He told the newspaper: “It’s kind of like a vegan going to the store and being forced to buy a steak. I’m being forced to buy a product that I will never use.” His premiums have increased more than 50%.

Fortune magazine reports that this is to be expected. Some businesses will see costs suddenly go down, but “so too may the quality of plans. That’s because the minimum qualifications the ACA put in place for health care plans will no longer apply.”

For instance, take Michelle Boyle Wadzinski, whose 18-year-old daughter, Eva, has epilepsy and needs about $5,000 worth of medications each month. In addition, Eva may need to have brain surgery. “Ms. Wadzinski, who isn’t currently working as she takes care of her daughter, says she values the cap on out-of-pocket costs that the health law requires, and the required benefits package,” the Wall Street Journal reported.

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