WASHINGTON — Some Minnesotans with employer-provided health insurance could find themselves with more out-of-pocket costs and coverage restrictions under the Republican health care bill, health policy analysts say.

Waivers that free individual states from certain federal coverage requirements are key to the GOP plan that passed the House of Representatives Thursday and now goes to the U.S. Senate. Put in place to win conservatives' votes, those waivers are supposed to lower the cost of health insurance in the individual market.

But an analyst from the Brookings Institution says large employer plans, which make up 85 percent of the nation's health insurance market, could choose to restrict coverage based on those waivers. That could affect basic benefits that are now guaranteed under the Affordable Care Act (ACA).

Workers also could be affected by changes in the definition of what is considered "essential" health coverage, said Matthew Fiedler, a fellow in the Center for Health Policy at Brookings, a Washington think tank.

Large employer insurance plans may adopt the definition of essential benefits of any state, Fiedler said, regardless of where their employees work. States that limit coverage could become the model for companies that want to save on insurance.

"That approach has very big implications," Fiedler told the Star Tribune.

Peter Nelson, a senior policy fellow at Minnesota's Center of the American Experiment, a conservative public policy advocacy group, counters that the waiver program would give states "more flexibility." Nelson said those with preexisting conditions who cannot afford traditional coverage would find it in federally subsidized high-risk insurance pools under the GOP bill.

"I really don't see this negatively affecting that many employees," he said.

The head of the Minnesota Council of Health Plans, which represents the state's insurance companies, said it's unclear yet what impact the bill would have on insurers.

"It's too soon to know how it will work with our businesses," said Jim Schowalter.

There's little doubt that the legislation could be subject to substantial changes in the Senate before any final bill is passed.

Groups representing health care consumers are decidedly against the legislation.

"Not one patient advocacy group thinks this is a good idea," said Allina Health CEO Dr. Penny Wheeler. "I expect substantial changes [in the Senate] to make this better."

Wheeler said the consequences of the bill would be "dire" for people with serious health problems and for the poor. She pointed to a Congressional Budget Office estimate that the American Health Care Act, as the Republican plan is known, will strip health insurance coverage from 24 million Americans over the next decade.

"We cannot expect better health if people are unable to access the services that promote and maintain health," Wheeler said. "Specifically, we are troubled by provisions that would permit states to waive requirements to cover essential benefits like cancer treatment, maternity care or mental health services …"

The Minnesota Medical Association, which represents doctors, said in a statement that it was "saddened by the vote," calling the Republican plan "a significant step backwards as an estimated 14 million fewer Americans would have coverage in 2018, growing to 24 million without coverage by 2026."

Hospitals, too, are worried about the Republican program.

Wendy Burt, vice president of the Minnesota Hospital Association, said her organization hopes "employers would want to continue to provide benefits."

"I hope there is a long conversation about the real cost of this bill as it goes to the Senate," she added.

The association, which represents 142 hospitals and health systems in the state, opposes the GOP bill on many grounds besides possible cuts to employer benefits. The bill will phase out coverage for 200,000 Minnesotans who got health coverage under an expansion of Medicaid by the ACA, Burt said. The bill also would take away virtually all of the money that's been used to provide basic health care to 100,000 people under MinnesotaCare.

"We really need people to have meaningful health insurance," Burt said. If the U.S. returns to millions of uninsured Americans getting crisis care in emergency rooms, she added, "it just drives costs up for everyone."

Fiedler of Brookings said the bill raises the prospect of some working people being forced to seek charity care through the reinstatement of lifetime limits on corporate benefits and the removal of caps on patients' annual out-of-pocket spending.

The ACA banned lifetime benefit limits for certain conditions and required a cap on yearly out-of-pocket spending for the insured. In 2017 those caps were $7,150 for individuals and $14,300 for families.

Jim Spencer • 202-662-7432