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Speaker 1: For seven years. Republicans have called the Affordable Care Act,

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Speaker 1: popularly known as Obamacare, a disaster, and they vowed to

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Speaker 1: repeal and replace it, but doing so has not been easy.

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Speaker 1: The Congressional Bust Budget Office scored the first two versions

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Speaker 1: of the Republicans American Health Care Act and said it

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Speaker 1: would result in both of them would result in twenty

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Speaker 1: four million people losing health insurance. House leadership has had

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Speaker 1: to contend with protests by hardcore conservatives that the bill

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Speaker 1: doesn't go far enough, and it's also had to contend

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Speaker 1: with complaints by other Republicans that the bill goes too far.

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Speaker 1: Changes made last night would eliminate the requirement that all

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Speaker 1: health insurance plans cover tennis cential health benefits, including hospitalization

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Speaker 1: of maternity care, but it isn't clear those changes will

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Speaker 1: get enough conservatives on board to pass the bill, and

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Speaker 1: the fate of the bill is up in the air

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Speaker 1: as we speak. With us to talk about the bill

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Speaker 1: and its chances of passage are Nicholas Bagley, a professor

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Speaker 1: at the University of Michigan Law School, and Alden Bianchi,

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Speaker 1: a member of MINTS. Levin Cone, Ferris Clouski, and Popio Nicholas. Um,

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Speaker 1: the the big change revolved at the last minute. You know,

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Speaker 1: the last round of changes seemed to revolve around these

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Speaker 1: essential health benefits um, that were required by Obamacare and

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Speaker 1: now seemed to be removed from requirements and health health

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Speaker 1: insurance plans provide. Can you explain to us what this

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Speaker 1: means for the bill? Sure? Uh? And I should say

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Speaker 1: right at the outset that it's actually not altogether clear

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Speaker 1: what the most recent changes mean for the bill. This

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Speaker 1: amendment was written in haste, and it is kind of

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Speaker 1: a train wreck of legislative language. Um. So let me

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Speaker 1: back up. The essential health benefits are those benefits that

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Speaker 1: health plans in the individual and small group markets have

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Speaker 1: to cover, and they include things like maternity services and

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Speaker 1: mental health coverage that lots of plans prior to the

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Speaker 1: a c A didn't cover. And Republicans object to the

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Speaker 1: price tag of those mandatory benefits, and they'd like to

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Speaker 1: make it easier for health insurers to strip them out. Um.

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Speaker 1: The Freedom calc has insisted on that as the price

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Speaker 1: of their vote, and so they got this funny amendment

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Speaker 1: to the bill into the bill last night that on

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Speaker 1: its face looks like it's an effort to strip out

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Speaker 1: the essential health benefits. It's not clear that it achieves

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Speaker 1: that goal. The only goal that it definitely achieves is

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Speaker 1: to introduce still more uncertainty into the individual insurance markets

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Speaker 1: for two thousand eighteen, it's um, like I said, kind

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Speaker 1: of a train wreck where we see haste making real waste.

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Speaker 1: All din does that include as well stripping away benefits

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Speaker 1: for drugs, prescriptions, and other things that are that seemed

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Speaker 1: essential to healthcare coverage, surgery, ambulance. It really could. Those

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Speaker 1: ten essential health benefits are are a laundry list of

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Speaker 1: things that include the items that you just mentioned. What's

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Speaker 1: curious is is you could get a long way towards

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Speaker 1: the whole list of tenor cential health benefits if you

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Speaker 1: just leave in the four key ones are the drivers

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Speaker 1: of of a plan's actual real value in patient hospital,

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Speaker 1: out patient hospital, imaging, and prescription drugs. But but that

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Speaker 1: could leave an awful lot of other things on the table,

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Speaker 1: and then you wouldn't know what you're buying from from

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Speaker 1: state to state or or market to market. Does your

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Speaker 1: plan include this? And not that I agree with Nicholas,

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Speaker 1: this is is it's really confusing. Nicho let's uh say

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Speaker 1: that that the legislative language problems that you you cited

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Speaker 1: are taking care of, and this really does eliminate the

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Speaker 1: essential health benefits requirement. Donald Trump in the campaign talked

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Speaker 1: an awful lot about the idea of selling insurance across

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Speaker 1: state lines. How does does the essential health benefits provision

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Speaker 1: affect that? It's a very good question, because what the

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Speaker 1: bill actually does is return authority to the states to

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Speaker 1: establish their own essential health benefits. So the states will

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Speaker 1: be the ones deciding what sorts of health plans can

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Speaker 1: be sold in their state. Well, how does that work

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Speaker 1: when you can sell plans across state lines? Then? You know,

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Speaker 1: I don't know how the two you know, I don't

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Speaker 1: know how the two requirements can play nicely with one another.

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Speaker 1: It seems like either a certain benefit is essential within

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Speaker 1: a state or it's not essential within a state. Um,

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Speaker 1: But allowing sales across state lines, that suggests that you

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Speaker 1: can buy plans that have bare bones coverage requirements from

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Speaker 1: a far distant state, even where your state has chosen

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Speaker 1: to cover a more expansive roster of essential health benefits. Again,

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Speaker 1: it's an unholy mess. Um. The two kinds of policy

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Speaker 1: changes they want to make just don't work well together. Well.

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Speaker 1: Some more of the uncertainty is whether or not this

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Speaker 1: bill is going to pass. Latest reports are that how

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Speaker 1: Speaker Ryan was going to the White House to speak

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Speaker 1: to the President about the prospects for passage, and there's

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Speaker 1: much speculation that he's telling the President that the votes

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Speaker 1: may not be there for this bill to get through

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Speaker 1: the House. There's also spec there's also some reports that

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Speaker 1: the President intends to blame Speaker Ryan if this does

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Speaker 1: not pass. So the politics of this seemed to be

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Speaker 1: at least as complicated as the legislative language that um,

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Speaker 1: we're having some trouble parsing out the meaning of