As Republicans look for ways to replace or modify Obamacare, many suggest that reducing the list of services that insurers are offered in individual and small group plans would lower costs and increase flexibility.
That option came in the week of February 13, when Seema Verma, nominated by President Donald Trump to head the Centers for Medicare & Medicaid Services (CMS), said at her confirmation hearing that coverage for maternity services should be optional in those plans.
Maternity coverage is a popular target and one frequently mentioned by critics of Obamacare , but other services that are now required by law could also be diluted or eliminated.
However, there are some important obstacles. Health law requires insurers selling policies for individuals and small businesses to cover at least 10 essential health benefits, including hospitalization, prescription drugs and emergency care, as well as maternity services.
The law also requires that the scope of services offered be the same as those typically provided in coverage through an employer.
“It has to look like an employer’s typical plan, and those are still pretty generous,” said Timothy Jost, a professor at the Washington and Lee University Law School in Virginia and an expert on health law.
Since the 10 required benefits are stipulated in the Affordable Care Act (ACA), it would require a change in the law to eliminate entire categories or dilute them to such an extent that they are less generous than typical employer coverage.
And since Republicans probably can not get 60 votes in the Senate, they will be limited in the changes they can make to ACA. However, policymakers say there is room for “slimming” in some areas by changing the regulations that federal officials wrote to implement the law.