With my husband battling cancer for the past two years, I have seen, firsthand, how quickly medical costs can skyrocket.
The House Republican’s repeal-and-replace bill would have a devastating effect on every family facing serious illness by repealing the essential benefits provisions in the Affordable Care Act, allowing insurance companies to reinstate annual and lifetime caps. This would include insurance coverage, like mine, received through an employer-sponsored insurance plan.
The ACA’s essential benefits provision requires insurance policies to cover services such as emergency room visits, prescription drug coverage, ambulatory services (such as doctor visits and outpatient treatment), hospitalization, laboratory services, mental health and addiction treatment, maternity and newborn services, preventive services (such as vaccinations), certain pediatric services, and rehabilitation services. Prior to the ACA, insurance companies in Pennsylvania were not required to cover many of those services.
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In addition, the ACA prohibited insurance companies from imposing annual and lifetime caps on coverage for those essential benefits. The Republican bill allows states to apply for a waiver from essential benefit coverage, leaving the state to determine benefit levels. In effect, without the essential benefits provision, insurance companies can reinstate caps, even for ESI plans.
Would Pennsylvania apply for a waiver? The Wolf administration supports the ACA, so perhaps not. But future administrations might. And, re-instituting annual and lifetime caps will put needed treatment for serious illnesses, like cancer, beyond the reach of many families.
Helen Sheehy, Tyrone