One of the perennial complaints about Obamacare, coming mostly from old white men, is that maternity coverage one of the essential health benefits the law said has to be included in all insurance plans. They, of course, think that means that they are paying for strange women's pregnancy with their premiums, and there's nothing more horrifying. Never mind that plenty of women have been helping to cover their prostate exams, and none of us spend a lot of time or energy resenting that. But the argument has trickled up the food chain, and trimming essential benefits—including maternity coverage—is on the table.
There are some big hurdles, however. The Affordable Care Act requires that insurers who sell policies for individuals and small businesses cover at a minimum 10 "essential health benefits," including hospitalization, prescription drugs and emergency care, in addition to maternity services. The law also requires that the scope of the services offered be equal to those typically provided in the coverage that businesses offer their employees.
"It has to look like a typical employer plan, and those are still pretty generous," says Timothy Jost, an emeritus professor at Washington and Lee University Law School in Virginia who has studied and written about the health law.
There's one big policy problem with that—by allowing insurance companies to sell plans that don't have mental health treatment, or substance abuse treatment, or hospitalization, or maternity care and offering them as supplemental plans, they'll charge a lot extra for them. As health policy expert Larry Levitt explains, "If benefits are not somewhat standardized, no insurer wants to be the one with the really comprehensive benefits … and all the sick people." Insurers will price those extra benefit plans so high that only those who must have them will buy in.
There's a political problem, too, as Republicans are finding out in town meetings this week.
Representative Scott Taylor, Republican of Virginia, when asked about a House Republican health care plan that would not provide maternity coverage, said he would push for such coverage to be included in any replacement plan, one of many examples where Republicans are likely to divide on policy and provisions. "There's discussion," Mr. Taylor said of the plan promoted by the House speaker, Paul Ryan. "It's not set in stone yet."
How can they argue to constituents that they're the pro-life, pro-family party when they are proposing such anti-family policies? Clearly at least one Republican—Taylor—can't, at least not to the faces of his constituents. Must be why so many Republicans are refusing to meet face-to-face with their constituents at all.