When I said insurance wouldn't be required to cover anything under Trumpcare, I may have said so for effect at the time, but I wasn't necessarily exaggerating.
According to various reports, House Republican leadership has amended their bill in a last-minute attempt to persuade some members of the Freedom Caucus to support it.
This is a list of what insurance would no longer be required to cover under the new version of their bill:
• Outpatient care without a hospital admission, known as ambulatory patient services
• Emergency services
• Pregnancy, maternity, and newborn care
• Mental health and substance use disorder services, including counseling and psychotherapy
• Prescription drugs
• Rehabilitative and habilitative services and devices, which help people with injuries and disabilities to recover
• Laboratory services
• Preventive care, wellness services, and chronic disease management
• Pediatric services, including oral and vision care for children
NBC News has a more detailed breakdown of what plans would no longer be required to cover.
Outpatient care — This covers most scheduled doctor visits, such as to check a rash, or a non-emergency stomach ache. Insurance companies negotiate deals for these and often designate "networks" of doctors and clinics with approved charges. Individuals who walk in without coverage pay much, much more.
Emergency room trips — Insurance policies cover both the ER visit and ambulance trips. Otherwise people can get socked with bills totaling tens of thousands of dollars, perhaps incurred while they were unconscious.
In-hospital care — All care people get as hospital patients, such as surgery. Some conservatives argue that people should be able to choose to opt out of this type of coverage and pay lower premiums. Most health policy experts say this is a gamble. "One answer is because someday you may be sick and that's the way that insurance works," says David Cutler, a Harvard University economics professor who helped design the Affordable Care Act.
Pregnancy, maternity and newborn care — This one's controversial to some, who ask why men should pay for a service they'll never use. Pre-Obamacare, many insurance policies specifically excluded maternity care. "It is true that women get pregnant but men kind of help them get pregnant," Cutler said.
Mental health and substance abuse disorder services — This particular benefit has gotten some attention with the ongoing opioid epidemic.
Prescription drugs — Insurance companies usually negotiate discounts. Out of pocket costs for many drugs can be much higher than what an insurer pays for them.
Rehabilitative services and habilitative services — These include help recovering from an injury or illness, but also treatment for kids with autism or cerebral palsy.
Preventive services — This includes vaccines, cancer screenings such as mammograms and colonoscopies and, controversially, coverage of birth control.
Pediatric services — Including dental and vision care for children.
So, in other words, insurance would be required to cover almost literally nothing. Insurance would be a worthless piece of paper.
This is what would have been included in follow-up legislation, or what Paul Ryan has referred to as a "three-pronged approach." It's not clear if adding these regulatory changes to the bill can be passed through reconciliation but, even in that case, it would take only 2 Republican senators to kill the bill and at least a dozen are leaning against it. And that was before House Republicans made the above changes.
Republican Senators Lisa Murkowski and Susan Collins would not support the bill as it was written, and they certainly won't if the above changes are included. Just those two would be enough to stop it.
Needless to say, medical bankruptcies will make a big comeback if this ever becomes law.