In their quest to repeal and replace Obamacare, three Republican lawmakers have offered an alternative proposal to the health reform law that would roll back some of its major consumer protections, including maternity care for pregnant women.
Now that Republicans have control of Congress, and a Supreme Court challenge against Obamacare threatens to undermine the current structure of the law’s state-level marketplaces, GOP lawmakers are under more pressure to put forth their own health care proposals. Over the past several years, the party has not been able to unite around a single Obamacare replacement, and outside observers have become increasingly skeptical that Republicans have any kind of viable alternative at all.
On Wednesday, three Republicans attempted to allay those concerns by putting forth the first health care plan the GOP has unveiled this year. The proposed “Patient Choice, Affordability, Responsibility, and Empowerment Act” has not yet been been translated into legislative language, so it’s unclear how it will operate in practice.
Nonetheless, it’s evident that the GOP lawmakers — Sen. Richard Burr (NC), Sen. Orrin Hatch (UT), and Rep. Fred Upton (MI) — are looking to undo many of the protections that Obamacare put in place for Americans who may struggle to afford insurance.
The Burr-Hatch-Upton plan would eliminate Obamacare’s expansion of Medicaid, which seeks to expand public health insurance to additional low-income people. It would also scale back the tax subsidies to help people purchase private plans. And it seeks to reduce federal regulation of “essential benefits,” dropping the current requirement for insurers to offer coverage for maternity care.
Obamacare mandates maternity coverage in all of the plans sold on its state-level marketplaces, a provision that quickly became a sticking point among opponents to the health law. Critics have latched onto it as an example of why they believe unnecessarily generous benefits will drive up health costs, complaining that having children is a choice and not everyone will need maternity care. During one House hearing, GOP lawmakers sarcastically asked former Health and Human Services Secretary Kathleen Sebelius if she had ever heard of a man getting pregnant. Now, the Burr-Hatch-Upton plan addresses their concerns.
Expanding access to maternity coverage is designed to address the gender-based disparities that were rampant in the individual market before Obamacare. The old system ensured that women ended up paying much more for their health care than men — largely because they require specific reproductive health services like birth control, mammograms, Pap smears, and, yes, maternity care.
Before the Affordable Care Act went into effect, maternity coverage was routinely excluded from the individual insurance market. According to the National Women’s Law Center (NWLC), just 12 percent of plans on the market offered coverage for pregnancy-related care. And giving birth without any type of insurance coverage is financially impossible for most women; childbirth in the United States costs more than anywhere else in the world.
Obamacare proponents argue that reducing women’s costs for maternity services will hopefully allow more of them to get critical health care, something that helps ensure healthy pregnancies and healthy babies. They say paying into a system that encourages those positive benefits will make for a stronger society.
For instance, Sen. Tom Harkin (D-IA) has made a social responsibility argument for maternity coverage, comparing it to the property taxes that fund public schools. “Maybe because my wife and I do not have any more children and they are grown up, maybe I should not have to pay property taxes to pay for my local schools,” he said at a legislative committee meeting in 2013. “We are better than that in this country. We are talking about being part of our society. It is to our benefit, my wife and I, to support our local schools because that is our next generation, we want them well taught. Same with health care. It is a values system.”
While it’s true that men do not get pregnant (although they certainly play a critical role in creating the condition), these are hardly rare procedures. A full 25 percent of all U.S. hospitalizations are a consequence of pregnancy and childbirth, according to an analysis from the Kaiser Family Foundation.
The Burr-Hatch-Upton plan is very similar to a GOP proposal introduced at the beginning of last year that never got off the ground. Still, according to the Washington Post, “health policy aides for Burr, Hatch and Upton said this plan could be the basis for the party’s long-term vision for health reform.”