Essential health benefits – what happened to the goal of affordable health care?

2013

A proposed rule on essential health benefits which must be included in any insurance in the health insurance exchanges under Obamacare has been issued by HHS. The regulations restate the ten categories that must be part of the benchmark plan.

Focus for a moment on the items I have highlighted in bold. The expansion of mental health services, especially when treated as any other illness, habilitative services and oral and vision care for individuals to age 19 are no doubt highly desirable for those directly affected, but they are costly and subject to abuse, to some extent questionable as an insurable risk and they will make health insurance less affordable to both individuals and the government subsidizing the coverage.

The devil is in the details as they say so the extent to which these services are covered will determine the final cost, but we have potentially opened pandora’s box. For example, under habilitative services a child who is not talking at the expected age, could receive speech therapy; think for a moment how many concerned parents would want this service. Or, since a married 18 year old with a job can be included under parents coverage under the law, will the parents coverage have to pay for all dental and vision care, including perhaps orthodontics at some point?

To clarify the relationship between the 10 statutory categories and the EHB-benchmark plan, in paragraph (a) we propose that the EHB-benchmark plan must provide coverage of at least the following categories of benefits described in section 1302(b)(1) of the Affordable Care Act: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services, including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.

With respect to the tenth category, we interpret “pediatric services” to mean services for individuals under the age of 19 years.

Consider this excerpt from a NYT article on this subject:

Karen M. Ignagni, the president of America’s Health Insurance Plans, a trade group, said the White House needed to focus on the affordability of coverage for consumers and employers.

In the 2008 campaign, Mr. Obama said he would lower annual premiums by $2,500 per family by the end of his first term. But after a quick look at the proposed rules on Tuesday, Ms. Ignagni said she was concerned that “many families and small businesses will be required to purchase coverage that is more costly than they have today.”