Politico spilled the beans yesterday that a former chief aid to liberal icon Nancy Pelosi may have turned traitor to squash the promise of health care reform. He says he wants to improve the law, but his partners in crime are a who’s who of corporations and special interest groups that tried to kill the law two years ago.

At issue is a process that the Department of Health and Human Services (DHHS) is undergoing to define the Essential Health Benefits that private insurers must offer if they take part in the state-based health insurance exchanges when -- and if-- the Affordable Care Act (ACA) actually goes into law in 2014.

When the ACA was written, we were promised that the exchanges wouldn’t end up being filled with shoddy plans that offered little-to-no coverage at premium prices. The expectation was that there would be a range of plans offered, from “platinum” Cadillac models on down to “bronze” Kia budget plans. The thing is, even the bottom of the barrel plan was supposed to offer decent preventive and chronic care services - and those services are at the discretion of the DHHS. It’s now up to the DHHS to decide what essential health benefits every plan, no matter how minimal, must include.

About a month ago, the prestigious Institute of Medicine (IOM) weighed in saying, in essence, that affordability might trump medical necessity in some cases. This bit of blood in the water has brought out the sharks who never wanted the ACA to pass in the first place and they’re all lined up on the side of stripping down those essential health benefits as much as possible.

The former Pelosi aid, Brendan Daly, has joined a coalition of those sharks, but claims it’s all about making things better:

“I’m working with the coalition because we want to make the law more affordable,” Daly said, adding that if the health plans sold in the insurance exchange are overpriced, then employers and employees won’t be able to afford them. “I think the Obama administration would agree.”

The old saying goes that you’ll end up with fleas if you lie down with dogs. I’m not sure what happens to you when you swim with sharks though.

Here’s hoping that Daly is sincere in his desire to make the ACA work for people in need (because of my huge respect for Pelosi and her staff from my work with them years ago I’m willing to give Daly at least a teensy bit of the benefit of the doubt that he hasn’t sold his soul for a paycheck). And here’s hoping that when the Essential Health Benefits are finally handed down by DHHS they actually work FOR people with HIV.

What I don’t doubt, however, is that the Chamber of Commerce and others who are a part of Daly’s coalition will do all they can to ruin the exchanges if they can. They couldn’t kill the bill outright, so how about starving it or making it so unattractive and worthless that no one signs up? If you want to fight back and give HHS a piece of your mind about what the Essential Health Benefits ought to include, you can attend regional listening sessions on this topic.