Photo: AP

Americans who obtain health insurance through their employers are poised to get screwed by a last-minute amendment to the House Republican healthcare bill.

Health policy analysts inform the Wall Street Journal that a provision of the bill would allow states to obtain waivers exempting them from certain Affordable Care Act regulations. Insurers in those states “could be freed from regulation mandating that they cover 10 particular types of health services, among them maternity care, prescription drugs, mental health treatment and hospitalization.”

Why is that important?

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Obamacare imposed a national standard for essential benefits required of insurers. In addition to the aforementioned services above, this includes others deemed essential by the ACA, including: ambulatory patient services (outpatient care), emergency room visits, pediatric services, rehabilitative services, and wellness services (physicals, cancer screenings, immunizations, etc.).

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Under Obamacare, these benefits were mandated in every state, but otherwise states were free to create their own lists of required benefits. Employers aren’t bound to the list provided by the state they’re in, however; they’re free to shop around and pick another state’s requirements, if they choose. In other words, an employer in Kentucky might find that the required benefits in Missouri are better suited to their employees needs—but they would still have to honor Obamacare’s Ten Essential Benefits.

Under the House bill, states may obtain waivers exempting them from certain benefits on the Obamacare list. How might this affect you?

Say you live in New York, where, hypothetically, the government has decided to mandate maternity care as an essential benefit. But you work for an asshole who’d prefer a new massage chair in his office rather than benefits for childbearing employees. And let’s say North Dakota has decided that maternity care is not an essential benefit. (Sorry, North Dakotans.) Even if your boss has never operated a business in North Dakota, has never been to North Dakota, and couldn’t locate North Dakota on a map to save his life, he could still choose to abide by North Dakota’s essential benefits list rather than New York’s.

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In the end, you could be six months pregnant—or maybe it’s your wife, or your sister, or your mother—hauling 20-pound boxes of copy paper around the office, hoping your baby isn’t born anemic or with a protein allergy because your health plan doesn’t cover the specialized, overly expensive baby formula necessary to stave off permanent mental and physical injury—what will later be termed a “preexisting condition” precluding your child from gaining access to healthcare coverage in the future (if some have it their way).

Of course, not everyone who runs a business is a stereotypical jerk. Good healthcare benefits attract employees and offering them is one way to compete for top talent. But pregnant women won’t be the only group affected by the Republican plan. Children with special needs, too, are expected to suffer.

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As the Washington Post reports, a provision of the plan would cut Medicaid by about 25 percent over the next 10 years (around $880 billion). Approximately 70 percent of school districts rely on Medicaid reimbursements to pay healthcare professionals that serve students with special needs. In an April 28 letter, the School Superintendent’s Association wrote that the Republican plan would strip “healthcare services and access away from America’s most vulnerable children.” The effect of transferring the burden of health care to states, they said, “would result in higher taxes, eligibility cuts or curtailed services for children,” the Post reports.

According to the New York Times, the Republican plan is currently opposed by the American Medical Association (AMA), the American Cancer Society, and the AARP. AMA President Andrew Gurman portrayed the bill as likely to cause “serious harm to patients and the healthcare delivery system,” adding that recently tweaks have done nothing to change the fact that “millions of Americans will lose their health insurance as a direct result of this proposal.”