So what will Obamacare cover?

Here I thought Obamacare would just cover abortions and euthanasia.  (Kidding!)

It is among the health-care law’s most important — and most daunting — questions: What health-care benefits are absolutely essential?

California legislators say acupuncture makes the cut. Michigan regulators would include chiropractic services. Oregon officials would leave both of those benefits on the cutting-room floor. Colorado has deemed pre-vacation visits to travel clinics necessary, while leaving costly fertility treatments out of its preliminary package.

Policy experts expected the Affordable Care Act to establish a basic set of health benefits for the nation, but the Obama administration instead empowered each state to devise its own list. When all Americans are required to purchase health insurance in 2014 or pay a penalty, they will find that the plans reflect the social and political priorities of wherever they live.

That nationwide patchwork highlights the difficulty of agreeing on what constitutes good basic health care, as well as the tricky balances that states face in weighing coverage vs. cost.

“I want a benefit package that gives people viable protection but not necessarily a Mercedes,” said Arkansas Insurance Commissioner Jay Bradford, who is still deciding what options to pick for his state.

If insurance plans cover too much, premiums could become prohibitively expensive. But if they skimp on coverage, the states could fail to deliver on the health law’s basic promise: extending quality health coverage to 30 million Americans.

States do have guidelines to work within: They must cover 10 broad categories outlined in the Affordable Care Act, including doctor visits, maternity care and prescription drugs. They also must use an existing health-insurance policy as a template, such as a small-group plan or the package for state employees.

Eleven states have settled on packages of essential health benefits or are close to doing so, according to the consulting firm Avalere Health. Twenty others are still in the process of choosing a plan.

While benefits for hospital care and doctor visits tend to look similar, coverage for alternative medicine and mental health services varies widely.

via Is acupuncture essential health care? Weight-loss surgery? Under Obamacare, states choose.

So some states will pay for fertility treatments, stomach-reduction surgery, and other elective procedures and some won’t.  (I wonder if my cataract surgery would have been covered.  I think I’d hesitate to make a claim for fear of getting the attention of the death panels.  [Kidding!])

Here are the ten areas that must be covered:

  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

So dental and vision will be covered for children, but not for adults.  Presumably, health insurance plans at work can still offer those and other benefits.  The question is whether the Obamacare mandates will have a flattening effect on insurance offerings.

A big problem with Obamacare is that it’s so complicated and no one knows what it will really do.

About Gene Veith

Professor of Literature at Patrick Henry College, the Director of the Cranach Institute at Concordia Theological Seminary, a columnist for World Magazine and TableTalk, and the author of 18 books on different facets of Christianity & Culture.

  • Pete

    A bigger problem with Obamacare is that the government camel is taking up more room inside the health care tent. The tent will begin to get smelly and the doctors and nurses will exit the tent. Patients will be left with the camel.

  • Pete

    A bigger problem with Obamacare is that the government camel is taking up more room inside the health care tent. The tent will begin to get smelly and the doctors and nurses will exit the tent. Patients will be left with the camel.

  • http://www.wordsofthislfe.ca Brian Reynolds

    I love my Canadian healthcare despite the US medical “industry” propaganda. But I agree it would not be practical for the US at this stage, too big and too complicated. I feel bad for you guys.

  • http://www.wordsofthislfe.ca Brian Reynolds

    I love my Canadian healthcare despite the US medical “industry” propaganda. But I agree it would not be practical for the US at this stage, too big and too complicated. I feel bad for you guys.

  • Med Student

    I was merely skimming a 13 page summary of Obamacare for a class yesterday and my eyes were glazing over. Anyone who has to read that whole bill, let alone implement it, has my sympathy. Those millions of people now thrown into Medicaid who assume this means they’ll actually have good access to care also have my sympathy. Few people like the program now and little gets changed under the PPACA.

  • Med Student

    I was merely skimming a 13 page summary of Obamacare for a class yesterday and my eyes were glazing over. Anyone who has to read that whole bill, let alone implement it, has my sympathy. Those millions of people now thrown into Medicaid who assume this means they’ll actually have good access to care also have my sympathy. Few people like the program now and little gets changed under the PPACA.

  • http://theoldadam.com/ Steve Martin

    The bigger the government…the smaller the citizen.

    That is true for all of the”services” that government “provides”.

  • http://theoldadam.com/ Steve Martin

    The bigger the government…the smaller the citizen.

    That is true for all of the”services” that government “provides”.

  • fws

    this looks like an experiment in health care in a federalist fashion. Each state will be experimenting with its own version.

    Isnt this sort of looking like what a conservative republican in favor of some form of health care would want to have happen? How is that part of this “confusing”? that different states have different laws has never been called “confusing” … its called federalism.

  • fws

    this looks like an experiment in health care in a federalist fashion. Each state will be experimenting with its own version.

    Isnt this sort of looking like what a conservative republican in favor of some form of health care would want to have happen? How is that part of this “confusing”? that different states have different laws has never been called “confusing” … its called federalism.

  • http://NA A. MacPhee

    One of the most problematic provisions of the PPACA is the Individual Payments Advisory Board (IPAB).

    The following two articles address the constitutional, medical, and policy problems with this unelected, bureaucratic board that can’t be removed by congress until 2017. And then, only by two thirds of Congress.

    http://www.heritage.org/research/reports/2011/01/obamacare-and-the-independent-payment-advisory-board-falling-short-of-real-medicare-reform

    http://www.cato.org/publications/policy-analysis/independent-payment-advisory-board-ppacas-anticonstitutional-authoritarian-superlegislature

  • http://NA A. MacPhee

    One of the most problematic provisions of the PPACA is the Individual Payments Advisory Board (IPAB).

    The following two articles address the constitutional, medical, and policy problems with this unelected, bureaucratic board that can’t be removed by congress until 2017. And then, only by two thirds of Congress.

    http://www.heritage.org/research/reports/2011/01/obamacare-and-the-independent-payment-advisory-board-falling-short-of-real-medicare-reform

    http://www.cato.org/publications/policy-analysis/independent-payment-advisory-board-ppacas-anticonstitutional-authoritarian-superlegislature

  • http://www.bikebubba.blogspot.com bike bubba

    Um, Med Student, wouldn’t (if I read your name correctly) the person helping to implement Obamacare be “you”, at least in part? (or at least called upon to cope with it?)

    My take here; 2700 pages, and the best guidance they can give is ten vague principles and leaving the rest to not one, but fifty death panels (plus the IPAB) among the states? And this is supposed to be an improvement?

  • http://www.bikebubba.blogspot.com bike bubba

    Um, Med Student, wouldn’t (if I read your name correctly) the person helping to implement Obamacare be “you”, at least in part? (or at least called upon to cope with it?)

    My take here; 2700 pages, and the best guidance they can give is ten vague principles and leaving the rest to not one, but fifty death panels (plus the IPAB) among the states? And this is supposed to be an improvement?

  • fws

    a macphee @ 6

    is this bureaucratic mechanism really so novel as far as bureacracies currently function? Isnt this sort of the norm for the fcc, faa, fda etc etc etc? how is is different?

  • fws

    a macphee @ 6

    is this bureaucratic mechanism really so novel as far as bureacracies currently function? Isnt this sort of the norm for the fcc, faa, fda etc etc etc? how is is different?

  • Med Student

    @7
    I’m not in the insurance business, bike bubba. I don’t have to set up all the exchanges or figure out what all the rules are going to be. So in that sense, I don’t have to implement Obamacare. I don’t have to read the whole frickin’ mess. It will no doubt affect physician practices for years to come, but for at least the first 10 years of my career I’ll be working in the military system, which as far as I know was left alone by the PPACA.

  • Med Student

    @7
    I’m not in the insurance business, bike bubba. I don’t have to set up all the exchanges or figure out what all the rules are going to be. So in that sense, I don’t have to implement Obamacare. I don’t have to read the whole frickin’ mess. It will no doubt affect physician practices for years to come, but for at least the first 10 years of my career I’ll be working in the military system, which as far as I know was left alone by the PPACA.

  • DonS

    Wow, fws @ 5, what a distorted view of federalism you have.

    Hint — when the federal government mandates a health care system, required in all 50 states, where each state MUST set up a health care exchange, and MUST ensure that the health insurance policies offered meet federal minimums in ten specified areas, that ain’t federalism. Federalism would be staying the heck out of this whole area and letting the states decide if they want to mandate coverage or leave it to the people to provide their own health care. To analogize, your version of “federalism” would be like telling the states that they must offer each school child a salad having spinach, tomatoes, beets, celery, and cheese, but they can decide between carrots and raisins. Oooh! — freedom!

    These coverage mandates are going to drive premium costs through the roof. It’s already started, with premiums increasing about 20% or so the past couple of years as mandates have kicked in. You couldn’t address the problem of affordable healthcare in a worse way.

  • DonS

    Wow, fws @ 5, what a distorted view of federalism you have.

    Hint — when the federal government mandates a health care system, required in all 50 states, where each state MUST set up a health care exchange, and MUST ensure that the health insurance policies offered meet federal minimums in ten specified areas, that ain’t federalism. Federalism would be staying the heck out of this whole area and letting the states decide if they want to mandate coverage or leave it to the people to provide their own health care. To analogize, your version of “federalism” would be like telling the states that they must offer each school child a salad having spinach, tomatoes, beets, celery, and cheese, but they can decide between carrots and raisins. Oooh! — freedom!

    These coverage mandates are going to drive premium costs through the roof. It’s already started, with premiums increasing about 20% or so the past couple of years as mandates have kicked in. You couldn’t address the problem of affordable healthcare in a worse way.

  • http://www.gslcnm.com Pastor Philip Spomer

    How about my daily medicinal $100.00 a bottle single malt scotch and Cuban Cigar?

  • http://www.gslcnm.com Pastor Philip Spomer

    How about my daily medicinal $100.00 a bottle single malt scotch and Cuban Cigar?

  • http://www.bikebubba.blogspot.com bike bubba

    Med Student; fine, but if you have anything to do with medical devices, the tax on those will affect you, as will Obamacare’s effects on military retention.

    Or, put differently, in 2700 pages unmolested by Congressional eyes or staffers, there is bound to be a “baby ruth bar” in the pool for just about everyone who is even peripherally involved in medicine.

  • http://www.bikebubba.blogspot.com bike bubba

    Med Student; fine, but if you have anything to do with medical devices, the tax on those will affect you, as will Obamacare’s effects on military retention.

    Or, put differently, in 2700 pages unmolested by Congressional eyes or staffers, there is bound to be a “baby ruth bar” in the pool for just about everyone who is even peripherally involved in medicine.

  • Med Student

    @12 I totally agree that Obamacare will have effects on me as a health care provider; that’s fairly self-evident. But as I said, I’m glad I don’t have to read all 900+ pages. Actually, just saw a video in class today that breaks it down in 9 minutes and seems pretty well-done (it is from before the Supreme Court ruling): http://www.youtube.com/watch?v=3-Ilc5xK2_E

  • Med Student

    @12 I totally agree that Obamacare will have effects on me as a health care provider; that’s fairly self-evident. But as I said, I’m glad I don’t have to read all 900+ pages. Actually, just saw a video in class today that breaks it down in 9 minutes and seems pretty well-done (it is from before the Supreme Court ruling): http://www.youtube.com/watch?v=3-Ilc5xK2_E

  • http://www.thediscernmentfiles.blogspot.com David Rosenkoetter

    The article states: “So dental and vision will be covered for children, but not for adults.” Could this be why Michelle Obama has horse-collared the FDA into school cafeteria tyranny? The Obama administration is already worried about how much womb-to-tomb mandates will end up costing. So, the first thing to go already is vision and dental insurance for adults.

  • http://www.thediscernmentfiles.blogspot.com David Rosenkoetter

    The article states: “So dental and vision will be covered for children, but not for adults.” Could this be why Michelle Obama has horse-collared the FDA into school cafeteria tyranny? The Obama administration is already worried about how much womb-to-tomb mandates will end up costing. So, the first thing to go already is vision and dental insurance for adults.

  • http://www.thediscernmentfiles.blogspot.com David Rosenkoetter

    The article states: “So dental and vision will be covered for children, but not for adults.” Well, no wonder Michelle Obama smooth-talked the FDA into implementing school cafeteria tyranny. The Obama administration already knows that its womb-to-tomb mandates will cost the government a lot more money than Medicare. So, they’re already shortcutting areas to save themselves some revenue.

  • http://www.thediscernmentfiles.blogspot.com David Rosenkoetter

    The article states: “So dental and vision will be covered for children, but not for adults.” Well, no wonder Michelle Obama smooth-talked the FDA into implementing school cafeteria tyranny. The Obama administration already knows that its womb-to-tomb mandates will cost the government a lot more money than Medicare. So, they’re already shortcutting areas to save themselves some revenue.

  • Chelle Burns

    ok i’m just a normal person here with a little extra education. No way i would ready that 900 pages of blah blah blah that could be summed up in probley 10 pages! I think they are wrong for not incuding Dental and vision care. Dental is one of the leading reasons for heart and allot of other health issues and imo when ur below or just on the guide lines of out presidents guidlines you cant afford it . IE my husband makes 34k a year, so were not “poor” but broke. i’m one of the millions of americans fighting to get on disability so no income from me. Now i need dental work and i have to *gasp* depend on the local mission just to get a bad tooth pulled. If he included dental even basic IE fillings, extractions,crowns, just nothing cosmetic then hed be saving allot of health issuse in the long run.

    I think i like the idea of his newest plan and i know before its over it will be rewritten a 100 times over b4 the end of this year alone but maybe someone might read this and the rest of what everyone is saying and go talk to him (so not holding my breath!)
    Sorry for ranting!

  • Chelle Burns

    ok i’m just a normal person here with a little extra education. No way i would ready that 900 pages of blah blah blah that could be summed up in probley 10 pages! I think they are wrong for not incuding Dental and vision care. Dental is one of the leading reasons for heart and allot of other health issues and imo when ur below or just on the guide lines of out presidents guidlines you cant afford it . IE my husband makes 34k a year, so were not “poor” but broke. i’m one of the millions of americans fighting to get on disability so no income from me. Now i need dental work and i have to *gasp* depend on the local mission just to get a bad tooth pulled. If he included dental even basic IE fillings, extractions,crowns, just nothing cosmetic then hed be saving allot of health issuse in the long run.

    I think i like the idea of his newest plan and i know before its over it will be rewritten a 100 times over b4 the end of this year alone but maybe someone might read this and the rest of what everyone is saying and go talk to him (so not holding my breath!)
    Sorry for ranting!


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