It’s a common question among those decrying the cost of health insurance: Why should you have to purchase a plan that covers procedures you won’t ever need? Especially if, say, you’re a guy, and your plan covers maternity care — as Obamacare requires most plans sold through an exchange to do?
It’s also a philosophy in conservative circles gaining momentum as Republicans try to deconstruct Obamacare: Everyone should have to pay for their own unique health plans; nothing more, nothing less. But it’s a philosophy that, when phrased the wrong way by the wrong person, can go terribly wrong.
On Thursday, Sen. Pat Roberts (R-Kan.) was asked by Talking Points Memo reporter Alice Ollstein whether he supports a proposal being floated by conservatives to get rid of Obamacare’s minimum coverage requirements. His response:
Roberts, perhaps recognizing that he just appeared to disparage a medical procedure that the American Cancer Society suggests all women over 45 should get, almost immediately apologized.
Here’s what he said in a separate statement to The Fix: “I deeply regret my comments on such an important topic. I know several individuals whose lives have been saved by mammograms, and I recognize how essential they are to women’s health. I never intended to indicate otherwise, and I apologize for my comments.”
(Worth noting: Men also get breast cancer.)
At issue here is what the 2010 Affordable Care Act deems “essential benefits,” or benefits so important all insurance companies have to cover them. They include such things as doctor visits, ambulance rides, prescription drugs — and maternity care.
Republicans are considering slashing those essential benefits at the request of the conservative House Freedom Caucus. Democrats say that would slash coverage to bare-bones plans. But if consumers want to buy bare-bone plans, they should be able to, conservatives argue.
But framing that debate in a gender-oriented way has felled several male lawmakers recently. Earlier this month, as the struggling Obamacare replacement bill was being debated in committee, Rep. John Shimkus (R-Ill.) asked this:
“What about men having to purchase prenatal care?” Shimkus said. “I’m just . . . is that not correct? And should they?”
“What a shocking display of ignorance and sexism,” the Chicago Sun Times editorial board responded.
In a town hall earlier this week, Kentucky Gov. Matt Bevin (R) made a joke about essential benefits that appeared to go over well in front of a conservative audience but drew the attention of national media:
“I don’t need maternity benefits because I don’t expect I’ll be expecting,” Bevin said. “Truth be told, I don’t think I’m alone in thinking that. There are women who frankly don’t want to pay for procedures they’re never going to need either.”
It isn’t just Republican men who cringe at the idea of having to buy a plan that covers pregnancy. President Trump’s chief of the Centers for Medicare and Medicaid Services, Seema Verma, recently said she doesn’t think women should universally have maternity coverage: “Some women might want maternity coverage, and some women might not want it or feel that they need it.”
The debate over essential benefits is a long-standing one and, for many conservatives, an important one, as it gets at the heart of how much involvement government should have in Americans' personal and financial decisions about their health.
Health insurance, like all insurance, works by pooling risks. The healthy subsidize the sick, who could be somebody else this year and you next year. Those risks include any kind of health care a person might need from birth to death — prenatal care through hospice. No individual is likely to need all of it, but we will all need some of it eventually.
So, as a middle-aged childless man you resent having to pay for maternity care or kids’ dental care. Shouldn’t turnabout be fair play? Shouldn’t pregnant women and kids be able to say, “Fine, but in that case why should we have to pay for your Viagra, or prostate cancer tests, or the heart attack and high blood pressure you are many times more likely to suffer from than we are?” Once you start down that road, it’s hard to know where to stop. If you slice and dice risks, eventually you don’t have a risk pool at all, and the whole idea of insurance falls apart.