GOP leaders are reportedly willing to eliminate guaranteed maternity care and other “essential health benefits” for a shot at their embattled American Health Care Act (AHCA) passing the U.S. House of Representatives on Thursday, but the move may have ultimately alienated ultra-conservative and moderate Republicans alike.
Politico first reported Wednesday evening that House Speaker Paul Ryan (R-WI) reportedly agreed to drop the essential health benefits, a set of ten categories of health services that health plans in the individual and small group health insurance markets must cover, in order to appease the far-right House Freedom Caucus members planning to vote against the AHCA. The benefits categories include pregnancy, maternity, and newborn care, as well as a wide range of preventive services, including contraceptives. Mental health and substance use disorder services are also on the list.
Dawn Laguens, executive vice president of Planned Parenthood Federation of America, blasted Ryan and his Republican colleagues for their “willing[ness] to sell out the moms of America to pass this bill.”
“Their latest gambit is to gut maternity care for a handful of votes,” Laguens said in a statement. “Women and men across the country won’t stand for this.”
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For members of the Freedom Caucus, the concession didn’t do enough to leave people without access to quality, affordable health care. They had more demands, such as cutting the popular Obamacare requirement to cover people with preexisting conditions. The billionaire Koch brothers are prepared to spend millions to shield congressional Republicans who vote against “Obamacare 2.0” from the White House’s wrath.
Ryan and company alienated moderates like Rep. Charlie Dent (R-PA) and other rank-and-file Republicans who said the latest changes would hurt their constituents even more.
A leaked GOP draft from mid-February gutted essential health benefits writ large, but by the time Republicans formally unveiled the AHCA in early March, they cut the benefits only for Medicaid beneficiaries—daring Americans to cast off the poor. Republicans instead intended to punt wider repeal of the fan favorites to the U.S. Department of Health and Human Services (HHS) amid widespread constituent backlash over unraveling Obamacare and defunding Planned Parenthood.
Under that plan, repealing the essential health benefits would occur in the second phase of what Republican leaders in both chambers have called a three-pronged approach to repealing and replacing Obamacare through the AHCA, agency-level action under anti-choice HHS Secretary Tom Price, and other GOP bills. Price is still expected to play a role in gutting Obamacare’s popular “birth control benefit,” as the requirement to cover contraceptives at no cost to the consumer falls under the Section 2713 Women’s Health Amendment.
Republicans haven’t concealed their entrenched ire toward Obamacare policies that help pregnant people and new parents. Rep. John Shimkus (R-IL) used the health-care policy-setting House Energy and Commerce Committee’s markup time to question why men should pay for prenatal coverage. The rebuke showed that many Republicans don’t understand how health insurance works.
The AHCA was already widely seen as dead on arrival in the U.S. Senate despite needing a simple 51-vote majority to pass it through a fast-track process known as budget reconciliation. A handful of rank-and-file Senate Republicans opposed the bill’s initial plan to end Medicaid expansion in 2020, which was later revised to end in 2018. And conservatives like Sen. Rand Paul (R-KY) don’t think “Obamacare Lite” goes far enough.
The latest move will make the bill even less palatable to Senate Democrats.
“The more desperate Republican leaders get to win over extreme House conservatives, the worse Trumpcare becomes. But let’s be clear: any member of Congress who is intent on taking away essential benefits like maternity care, birth control coverage, and mental health services is in for a rude awakening if this bill ever gets to the Senate,” Sen. Patty Murray (WA), the top Democrat on the Senate Health, Education, Labor, and Pensions Committee, said in a statement. “Democrats will fight back and these harmful measures will not survive.”
Republicans’ 2015 effort to repeal Obamacare didn’t gut essential health benefits. A Senate Democratic aide warned that doing so this time around would “almost certainly violate” the Senate’s Byrd rule, which puts the kibosh on provisions in a budget reconciliation bill that are “merely incidental” to the budget. In other words, Congress can’t wield the reconciliation process for the sake of a political agenda.
“This will be struck,” the aide told reporters.
Ryan presumably knows that’s a real possibility. Politico reported that his office had received “assurances,” by unspecified sources, to the contrary, “though some legislators worry that’s not true” and will face the wrath of Byrd.
“This is merely a plot to get the bill out of the House,” Matt House, the communications director for Senate Minority Leader Chuck Schumer (D-NY), said in a Tweet. “Provision won’t ultimately survive in the Senate.”
Regardless of Senate prospects, Ryan needs to pass the bill out of the House, and quickly, to keep up the momentum on Capitol Hill. Senate Majority Leader Mitch McConnell (R-KY) plans to take up the bill with or without support next week before Congress recesses for the Easter holiday.
“I would hate to be a Republican whose vote prevented us from keeping the commitment we’ve made to the American people for almost ten years now,” McConnell told the Associated Press on Tuesday. Per Politico, McConnell later clarified that his comments constituted a “statement of the obvious” rather than a threat.
There’s still no updated Congressional Budget Office score that accounts for the new changes. Last week’s damning estimate from Congress’ independent, nonpartisan data crunchers found that the initial, unamended AHCA bill could cause 24 million people to lose their health insurance coverage. The provision to strip Planned Parenthood, and only Planned Parenthood, of Medicaid reimbursements for one year would disproportionately hurt the poor and those who live in rural areas.