What Happens if Insurers No Longer Have to Cover ACA’s 10 Mandated Benefits

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 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 mandate fuels insurers’ concern about how to control the costs of benefit packages, as Managed Care noted in 2011. Now, the Wall Street Journal digs down to see just 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 tells the Wall Street Journal: “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%.

Then there’s Michelle Boyle Wadzinski, whose 18-year-old daughter, Eva, has epilepsy and needs about $5,000 worth of medications each month. In addition, she may 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 reports.

Wadzinski told the newspaper: “It would be a really bad thing if drug benefits aren’t mandated.”

Source: Wall Street Journal