Republican leaders have been trying to reassure the critical number of House Republicans worried that the current health-care bill would "torpedo" protections for people with pre-existing conditions, as Rep. Fred Upton (R-Mich.) put it on Tuesday, in part by insisting that very few states would actually use the allowed waivers to scrap "essential health benefits" or rules preventing insurers from charging more due to pre-existing conditions. But to paraphrase President Trump, health care is complicated, and even one state messing with the essential benefits guaranteed under the Affordable Care Act could affect health insurance nationwide, says health economist Matthew Fielder at the Brookings Institution.
"In particular, a single state's decision to weaken or eliminate its essential health benefit standards could weaken or effectively eliminate the ACA's guarantee of protection against catastrophic costs for people with coverage through large employer plans in every state," he writes. ObamaCare bans limits on annual and lifetime health expenditures and requires insurance plans to cap out-of-pocket costs, but only for the defined essential health benefits. If these benefits are eliminated partially or completely, Fielder says, so are the cost protections for those benefits.
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