In the GOP's Hunt for Votes, It's All About Essential Health Benefits

House leaders are balancing the need to win votes from conservative members with the need to not put moderate members at risk.

As House Republican leaders and President Donald Trump scramble for the last of the votes they need to pass the latest version of the American Health Care Act (AHCA), the word is out: it’s coming down to whether Republicans try to strip the essential health benefits out of the Affordable Care Act (ACA).

The essential health benefits are coverage for 10 core areas—including mental health and preventive care—that are required in marketplace plans under the ACA. Until now, Republicans have stayed away from trying to carve them out of the AHCA, since it hinges on a budget resolution. Go too far beyond what relates directly to the budget, and the Senate parliamentarian could say it’s beyond the scope of what’s allowed under a vote not subject to the Senate filibuster rules.

But keep the essential health benefits in, and the House Republicans risk losing members of the Freedom Caucus, the hard-right conservative members who object to the essential health benefits on 2 grounds: first, they represent the overregulation they dislike about “Obamacare,” and second, they drive up the cost of premiums and out-of-pocket expenses.

However, stripping out the essential health benefits has House GOP moderates worried that the leadership now puts them at risk—why make them take a risky vote on a bill unpopular in their districts if the Senate is going to strip out the provision?

Those who treat patients in safety net hospitals were reacting quickly to the deal-making.

"Eliminating commonsense requirements that private plans provide a minimum package of essential benefits [w]ould make this damaging bill even worse," Bruce Siegel of America's Essential Hospitals said in a statement. "It could leave countless people with too little coverage to meet their health care needs and drive higher rates of uncompensated care at hospitals already struggling to cover their costs."