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GOP Obamacare Alternative Doesn’t Cover Contraception, Maternity Care

Emily Crockett

The day after House Republicans voted for the 56th time to repeal Obamacare, three congressional Republicans offered an alternative plan that would leave the decision on which “essential health benefits” to cover up to the states.

The day after House Republicans voted for the 56th time to repeal Obamacare, three congressional Republicans offered an alternative plan that would not guarantee coverage of either maternity care or contraception.

Both maternity care and contraception are guaranteed benefits under the Affordable Care Act (ACA), and contraceptives have to be covered with no co-pay. The decision on which of these and other “essential health benefits” to cover would be left up to states, under a new plan released Wednesday by House Energy and Commerce Committee Rep. Fred Upton (R-MI), Senate Finance Committee Chairman Orrin Hatch (R-UT), and Sen. Richard Burr (R-NC).

Because the plan is to repeal the health-care law in its entirety, that also means the contraceptive benefit would be repealed, Tom Wilbur, a spokesperson for Rep. Upton, confirmed to Rewire. 

Before the passage of the ACA, only about 12 percent of insurance plans covered maternity care, and more than half of women had at some point had trouble affording the birth control they needed.

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Before the ACA banned gender disparities in insurance premiums, women used to pay much more for insurance than men—even for many plans that didn’t offer any maternity coverage.

The plan would also make subsidies less generous, replacing a subsidy for people making up to 400 percent of the federal poverty level with a tax credit for those making up to 300 percent. The Republican plan would eliminate the ACA’s Medicaid expansion, turning instead to block grants that would likely shrink over time and benefit fewer people from the outset.

The plan would only forbid discrimination based on preexisting conditions for people who are continuously insured, which could turn a job loss or long-term unemployment into a health hazard.

Also left up to the states under the new GOP plan would be any and all health-care exchanges. The plan would eliminate the federal health exchange—which insures about 7.5 million of the ten million people who have coverage through the public exchanges this year.

Republicans don’t specify what would happen to those millions of people’s insurance plans.

A list of frequently asked questions about the plan prepared by the House commerce committee doesn’t give a straight “yes” answer to its own first question: “If consumers like the health plan they have, with your plan, can they keep it?”

Fourteen states so far have set up their own exchanges. Residents of the other 36 states are already in danger of losing their ACA subsidies depending on how the Supreme Court rules in King v. Burwell, in which the plaintiffs seek to end the federally run exchanges.

That case, and the likely catastrophe it would bring upon the insurance market if the subsidies are struck down by the conservative Roberts Court, has motivated the GOP to start talking more about their ideas for replacements, even if those ideas aren’t fully realized.

The new proposal, which hasn’t yet been written up into actual legislation, doesn’t include a formal estimate of the cost or the number of people who would be covered, and there are no plans for formal hearings on it.

Sen. Ron Wyden (D-OR), ranking member of the Senate Finance Committee, issued a statement calling the proposal a “lethargic rehash” of a similar proposal that didn’t go far in 2014.

“It effectively raises taxes on the middle class, removes bedrock protections for consumers and chips away at key coverage benefits that Americans rely on,” Wyden said.

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