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Drugs are portioned out at the Clay-Battelle Community Health Center’s pharmacy March 21, 2017 in Blacksville, West Virginia. The Republican-controlled House of Representatives is set to vote soon on a key plank of Trump’s legislative agenda: His plan to repeal and replace Obamacare. (BRENDAN SMIALOWSKI/AFP/Getty Images)

By Meg Wagner

The road to ‘meaningless coverage’?

In a last-minute bid to get their health care bill passed, House Republicans are considering killing federal regulations that require insurers to cover basic health services, such as maternity care, prescription drugs, and mental health services, in plans offered to consumers.

The proposal could woo on-the-fence conservatives into voting for the American Health Care Act, a Republican plan to repeal and replace the 2010 Affordable Care Act (ACA), also known as Obamacare, by reducing the number of regulations. A bloc of House Republicans has vowed to oppose the bill — dubbed “Trumpcare” — because it retains many of Obamacare’s requirements.

Obamacare mandates that all health insurance plans must cover ten areas of “essential health benefits”: Doctor’s visits, emergency services, hospitalization, maternity care, mental health and substance abuse treatment, prescription drugs, lab tests, pediatrics, rehabilitation, and preventative services.

Some Republicans have taken issue with the fact that the regulation means that some Americans end up paying for care they don’t need. For example, when putting men and women into the same risk pool — i.e., creating one insurance plan to cover everyone — basic women’s health care costs are then borne by the entire pool. But one House Republican, for instance, questioned why men should pay for prenatal care when they can’t get pregnant.

Doctors and patient advocates have lauded the ACA’s essential benefits requirement, arguing that it protects patients by ensuring that they have basic coverage — even for services they don’t think they’ll need — while lowering the overall cost for the pool. Without an essential benefits requirement, healthy young adults, for example, might choose to forgo emergency benefits, which could leave them uncovered if they have a medical emergency in the future, and those who assume they’ll need such benefits have to pay higher costs for access to them.

Nixing the basic benefit provision could mean insurers would be allowed to offer skimpy plans that cover very few services, health advocates warned.

“I’m afraid if they get rid of the essential benefits, you’ll have meaningless insurance. Meaningless coverage,” Dr. John S. Meigs Jr., president of the American Academy of Family Physicians, said. “We need benefits to make insurance meaningful.”

Unpopular among liberals, conservatives, and centrists

Repealing Obamacare has been a top priority for Republicans since the law’s inception. President Donald Trump ran on a campaign promise to get rid of the legislation, and House Republicans unveiled the Trumpcare plan to repeal and replace it on March 6.

But the Republican bill faced massive backlash from inside its own party. Trumpcare — like Obamacare — provides federal funds for health care expenses, but it changes the way that the government doles out that money. Where Obamacare provided large federal subsidies to low- and middle-income Americans to purchase insurance, the new plan gives out age-based tax credits, with older Americans getting larger payouts.

The fact that Trumpcare still provides federal funds to individuals for healthcare hasn’t gone over well with conservatives, who have called it “Obamacare 2.0” and “Obamacare-lite.”

Conservatives have also bashed the bill for maintaining many of Obamacare’s regulations — like the essential benefits rule and even the popular provision banning insurance companies from denying coverage to people with pre-existing conditions.

Meanwhile, Democrats have insisted that Trumpcare’s likely less-generous tax breaks would harm low- and middle-income families. A March 13 report from the Congressional Budget Office added to liberals’ fury after the nonpartisan group found that the Trumpcare plan will double the number of uninsured Americans in the next decade.

And Democrats and Republicans alike have balked at the bill’s plan to phase out expanded Medicaid programs, which provided about 11 million low-income Americans with insurance.

‘The votes just aren’t there’

The proposal to undo Obamacare’s essential benefit regulation could convince more conservative representatives to back the Trumpcare bill.

The right-wing House Freedom Caucus — which has opposed the bill since its introduction and previously suggested it had enough no votes from its members to prevent it from passing — said on Wednesday night that they had reached an “agreement in principle” with President Trump over the bill. The group’s chairman, Rep. Mark Meadows (R-N.C.), did not specify if the plan to nix the essential benefit provision was part of the agreement. The caucus then announced on Thursday afternoon that no deal had been reached to earn its members’ votes.

But the same regulation-bashing plan could also alienate more moderate Republicans. In the past day, at least six center-right representatives announced they would not vote for the legislation.

If Democrats stand united against the bill — and they are expected to do so — Republicans can only afford 22 no votes. The bill would then head to the Senate, where it would face an even tighter margin for passage.

Republicans have sought to pass Trumpcare under reconciliation, a political maneuver that allows budget bills to pass with a simple majority vote and avoid a potential filibuster. That means that Trumpcare backers only need 51 yes votes in the Senate, which has 52 Republican members.

But if the anti-essential benefits plan goes through, it may make the bill ineligible for reconciliation, Democrats have warned, because Obamacare’s benefit requirement has not been considered a budget issue. In that case, 60 senators would need to vote for the bill in order for it to avoid a potential filibuster and be passed.

Senate Republicans were already struggling to get the 51-vote majority, with at least four party members indicating they’d vote no because of the Medicaid repeal alone. Coaxing a handful of Democrats to vote for the bill in order to get the 60-member majority is a nearly impossible feat.

“The votes just aren’t there in the Senate,” Sen. Chuck Schumer (D-N.Y.) warned.

A vote in the House could come as early as Thursday.