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With House Republicans on the verge of passing a long-awaited health care overhaul, the future of US insurance coverage hinges on three words: essential health benefits.

The GOP’s proposal to let states define on their own which benefits all insurance plans must cover — prescription drugs? hospitalizations? childhood vaccinations? mental health? — would fundamentally reshape insurance for millions of Americans. It would likely drive down premiums, as plans with skimpier coverage would spring up in states which granted more flexibility. But it could drive up costs for individuals, by leaving them responsible for far more out-of-pocket expenses.


And this shift wouldn’t just affect people buying insurance on the individual market. It could also affect the more than 156 million people who rely on insurance plans sponsored by their employers.

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  • The repeal of the ACA is actually a rollback in regulation to 1998 level because of a standstill in a WTO trade agreement on services that the US was the main advocate for. My guess is that India asked for it and said they would bring another dispute up with the WTO which they would invariably win. This is because of their Trade Facilitation Agreement on Services proposal which hopes to force countries like the US to make our health and Social Security benefits portable. It all begun with the services agreement in 1994, where we committed to open our markets to globalization to lower wage costs and increase profits. So the future of US health care is likely at least in part care rendered overseas. The WTO rules contain a requirement that no measure of general application affecting trade in services be any more burdensome than necessary to ensure the quality of the service. It also requires that measures be minimally trade restrictive. This seems to me to indicate that the principle of proprtionality will require that location of care be used to provide a distinction, for commercial purposes, to distinguish quality levels or tiers. The scope of the agreement is very broad and exclusions (“public services”) are limited to service sectors that are completely free and noncommercial only.

    For the purposes of this Agreement:
    “measures by Members” means measures taken by:
    (i) central, regional or local governments and authorities; and
    (ii) non-governmental bodies in the exercise of powers delegated by central,
    regional or local governments or authorities;
    In fulfilling its obligations and commitments under the Agreement, each Member shall take such reasonable measures as may be available to it to ensure their observance by regional and local governments and authorities and non-governmental bodies within its territory;
    (b) “services” includes any service in any sector except services supplied in the exercise of governmental authority;
    (c) “a service supplied in the exercise of governmental authority” means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers.

    Additionally, Article 1:4 prohibits discrimination against corporations by country of origin.

    Read the paper at the link below.

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