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.
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:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management, and
- 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.