HHS issued regulations last July on the preventive measures that insurers must cover with no cost-sharing, but as part of the new law, the agency was to review preventive services specific to women’s health and could include further guidelines, which were issued yesterday. Last week, the Institute of Medicine (IOM) released its recommendation that the new regulations should include the full range of contraceptives, including sterilization procedures. Also to be covered with no cost-sharing were well-woman visits, screening for gestational diabetes, HPV DNA testing, STI counseling, HIV screening and counseling, breastfeeding support, and domestic violence screening.
HHS advertised that the new guidelines would expand available services “at no additional cost” to women, but as the AP’s Ricardo Alonso-Zaldivar writes, “Although the new women’s preventive services will be free of any additional charge to patients, somebody will have to pay. The cost will be spread among other people with health insurance, resulting in slightly higher premiums.”
The relative ease with which HHS adopted all of the IOM’s recommendations—and their associated costs for insurers and ultimately, patients—does not bode well for the forthcoming regulations on federally defined “essential health benefits,” which will determine what benefits must be included for health plans to participate in the new exchanges. Health policy expert John Hoff explains:
If the definition lists particular services that must be covered, it starts down a road of infinite complexity and overwhelming detail. If, for example, diagnostic services are included, will the definition list MRI scans as a required diagnostic procedure? Even if it does, the definition would be meaningless unless it goes on to specify under which conditions an MRI must be covered. Which symptoms require an MRI scan rather than a less-expensive x-ray? How long must the patient have experienced the symptoms?… It is impossible for HHS to define the circumstances for each and every treatment.
Taking a more prescriptive approach will result in major headaches for providers and insurers to determine what is and isn’t covered under what circumstances and, even worse, will raise costs even further for patients. Experiences with state-mandated benefits in places like Maine have already proven that this is the case.
Finally, allowing the government to mandate health benefits creates an avenue for special interest groups to lobby for certain services or products to be deemed “essential.” The women’s preventive services regulations are a prime example. As Heritage’s Chuck Donovan explains in an upcoming report, Planned Parenthood and others lobbied the IOM to include the widest possible range of drugs and procedures in its recommendations, a position that was fully adopted in the final document. Though HHS Secretary Kathleen Sebelius announced that the recommendations were “based on science,” the opinion of one member of the IOM board was the opposite:
The view of this dissent is that the committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee’s composition. Troublingly, the process tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy.
Indeed, the Council for Affordable Health Insurance warns in its annual survey, “For almost every health care product or service, there is someone who wants insurance to cover it so that those who sell the products and services get more business and those who use the products and services don’t have to pay out of pocket for them.”
Obamacare will lead to higher premiums and fewer choices as a result of its overly prescriptive approach to mandated coverage. This, combined with the other factors contributing to rising premiums, will lead more young and healthy Americans to choose not to purchase health coverage—achieving the opposite effect of what was intended by the preventive care measures.
Mandating health benefits is bad health policy, and not only that, it’s unnecessary. In a consumer-driven marketplace, insurers would offer the benefits that were attractive to patients, who would be able to choose from plans that met their health needs and did not threaten their values.
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