The federal health care law tells "the American people precisely what type of coverage they have to have."
Mitt Romney may no longer be a presidential candidate, but he remains a vocal critic of President Barack Obama, particularly Obama’s health care law. During an appearance Jan. 5 on Fox News Sunday, the Republican and former Massachusetts governor weighed in on the Affordable Care Act as it enters an important year of the rollout. "It's not just that the president tells people that they have to buy health insurance; it's that he tells them what health insurance they have to buy," Romney said. "The idea that the government knows better than the American people what kind of insurance they have to have makes no sense, and it's something ... I think the American people are rejecting in large numbers." Romney put it more succinctly later in the program when he said that the federal health care law tells "the American people precisely what type of coverage they have to have." This issue came up quite a bit toward the end of 2013, when millions of Americans discovered their current health insurance policies did not meet minimum standards for coverage required by the law. But is it fair to say the federal government is telling Americans what insurance they have to buy and dictating the type of coverage they must own? For insurance sold on the individual market — i.e. plans purchased individually and not through an employer — there are requirements of what’s included in a policy. The administration calls them the 10 "essential health benefits." They are: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services Plans sold in the individual markets must meet those requirements. That means some people who aren’t thinking about having children — or can’t have children — will still need to purchase coverage for maternity care and pediatric services. Others who don’t regularly rely on prescription drugs will still pay for a plan that includes it. Critics, such as Romney, say this requires people to pay for coverage they don’t need or want. Proponents say the alternative (a.k.a. pre-Obamacare) was an individual market where people were often paying for plans that actually provided very little coverage and the new law sets minimum standards. And, like plans purchased through your employer, requiring everyone to pay for certain coverage, even if they don’t need it, will spread the risk around and keep the cost lower for everyone. In practice, it means fox example that men and women will pay the same rates for equivalent coverage, and women won't be charged more because they can have children. The 10 essential health benefits apply to any plan that has not been grandfathered into the law. In practice, that includes all of the plans purchased in the individual markets offered by the federal government or states. It also includes any businesses with 50 or more full-time employees who previously did not offer insurance to their workers (Obama delayed the employer mandate until 2015). To be clear, there’s still choice in the individual market. While there are minimum coverage requirements regardless of the policy, 95 percent of consumers who buy insurance on the federal marketplace will have a choice between options offered by two or more insurance providers. In the 36 states where the federal government is running or assisting the marketplace, the average consumer has a choice between 53 health insurance options. Those choices range from less costly catastrophic insurance for younger adults to the higher-tiered bronze, silver and gold plans. Consumers can choose to pay more for more coverage and benefits. So Romney is right that the health insurance law is mandating some type of coverage, but he’s exaggerating as to the extent. That’s even more true for Americans who already receive their health insurance through an employer. Their plans are not required to offer the 10 essential benefits if they were in place before March 2010, though they are required to make some more minor changes. One of them requires insurers to spend at least 80 percent of someone’s premium on patient care. Employers also cannot significantly decrease the benefits, or risk losing grandfathered status, but they can make changes. (For the record, individual plans also can avoid the 10 essential benefits if they are considered grandfathered under the law. That’s easier said than done, however, and prompted the cancellations letters that came out last year. Obama has asked that some old, expiring plans remain on the books one more year before transitioning out.) Our ruling Romney said the administration is telling "the American people precisely what type of coverage they have to have." We were unable to reach Romney. The health care law does mandate some types of coverage, and for some people, requires 10 essential health benefits. But it’s not nearly as sweeping as Romney makes it sound. The biggest changes are on the individual market, while people who get their insurance through an employer will see far fewer major changes, if any. We rate his statement as Half True.
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