10 Things Obamacare Requires That Even Republicans Will Use

The Republicans, in their flailing attempts to discredit the Affordable Care Act, are tangling themselves in their web of deceit. (Surprise, surprise.) Exhibit A in this process is the willful misrepresentation about the changes that are happening to crappy individual health care plans.

Some individual insurance plans are indeed being cancelled–but only because they do not meet the set of 10 required minimum benefits, because they have lifetime maximum caps, because they reject people with pre-existing medical conditions–all bad practices that are outlawed by the Affordable Care Act. In short, the ACA dumps the bad and replaces it with the good.

One of the great benefits of the Affordable Care Act is its requirement that insurance coverage provide a basic set of 10 essential benefits, such as maternity care, prescription drugs, mental health treatment, free preventative care and a basic standard set of minimum coverages. Any health care plans that existed before the Affordable Care Act are being superseded by better, cheaper plans that offer the minimum coverages and, amazingly, at a cheaper rate than before. The latter fact may be related to the requirement within the Affordable Care Act that 80% of premium dollars collected by insurance companies be actually spent on patient care and anything over that not be diverted to profit for CEOs. The overcharges must be returned to the premium paying customers. That happened for the first time last August when insurance buyers had the bizarre joy of receiving rebates from their insurance companies because those companies had charged more than the 80% minimum.

But now the Republicans–facing the reality that the myths they have pushed for decades (that government is useless) are about to be shown for the lies they are–are flailing in every way imaginable, trying to lie their way out of the corner that is the effectiveness of the Affordable Care Act.

Surely, the Affordable Care Act is going through some growing pains as it tries to get the HealthCare.gov site running correctly–but those are transient problems that will get fixed and then it will be smooth sailing. The website’s woes are understandable and have no relation to the great benefits provided by the law.

Recall that the Affordable Care Act requires a minimum set of coverages such as the free preventative care? Well, obviously, health care plans that don’t provide that minimum coverage need to be replaced by better plans that do. Guess how the Republicans are trying to spin that. They’re trying to sidestep the fact that crappy plans are being replaced by good plans by saying that this is “coverage being cancelled”.

Fortunately, there are a few out there unwilling to wink at this lie. Former NPR reporter Juan Williams, currently ensconced at Fox News, was not willing to allow that lie to pass. Williams clearly said those plans were being cancelled because they were not good enough–because they don’t meet the 10 essential benefits–not because they are being cancelled. The Republicans are so dishonest at their core they are willing to lie about anything. In a word, the Republicans with regard to their statements about the Affordable Care Act are simply despicable.

So, what are those 10 essential benefits?

1. Preventative and Wellness Services. This seems like a no brainer. If we can prevent people from getting sick then their lives will be better and overall healthcare costs will be lower. (It seems amazing that the Republicans would fight this but if President Obama said the sky was blue, the Greedy Old Parasites party would quibble.)

2. Laboratory Services. The law lays out a set of preventative lab tests that must be covered–another common sense item that should be above argument, including prostate exams and Pap smears.

3. Pediatric Care. Under the Affordable Care Act, children under 19 must be covered for getting their teeth cleaned twice a year and X-rays, fillings and medically necessary procedures. An eye exam must be covered for kids too. (Though none of us are surprised that the Republicans would like to punish low-income children, this seems pretty common sense.)

4. Maternity and Newborn Care. Requiring an insurance plan to cover pregnant mothers and their newborns. If a woman has insurance then the Affordable Care Act requires the insurance those mothers are paying for to actually cover their pregnancy. Shocked. Shocked. (Obvious why the Republicans would be opposed to this, as their interest in protecting poor children stops the moment they are born. As long as their mothers are not getting abortions, the Republicans are satisfied.)

5. Ambulatory Patient Services–which means outpatient care. That means insurance plans must cover it when you walk into a doctor’s office–get treatment–and walk out.

6. Prescription Drugs. Though many old-style plans would cover this for extra charges, the Affordable Care Act requires insurance companies to cover a minimum of one drug in every category in the U.S. Pharmacopeia, which is the official guide to approved drugs.

7. Emergency Care. You walk into an emergency room with the symptoms of a heart attack or a stroke. The Affordable Care Act merely states that your insurance company cannot require a pre-authorization for this. If you’re gushing blood, you shouldn’t have to bleed out in the waiting room for your insurer to give the okay.

8. Mental Health Services. This used to be one of the rarest coverages but going forward this must be covered. Certainly there can be a co-pay such as $40 a visit but still this must be covered.

9. Hospitalization. If you need to go into the hospital, your insurance certainly should cover it. You may still be asked to pay 20% of the cost but at least your insurance company cannot just cancel you the moment you really need coverage, as they could before.

10. Rehabilitative or Habitative Services. If you get in an accident, often half the battle is getting back on your feet. If you’ve had a stroke, getting the ability to talk is a challenge. The Affordable Care Act acknowledges this need and makes this a part of insurance, no questions asked.

Edited/Published by: SB



Author of the bestselling novel "The Butcher of Leningrad" (a thriller). Novelist, Software Architect, Painter Native of Nebraska, Resident of Indiana, Citizen of the World   Software Architect for 16 years: Insurance, Healthcare, Wall Street Author of the bestselling novel "The Butcher of Leningrad". BA in Journalism from the University of Iowa. Minors in Russian, Computer Science Reporter and Columnist for the Daily Iowan in Iowa City, Iowa Editor for Neva News in St. Petersburg, Russia Editor and Publisher of Noggin Magazine in Iowa City, Iowa