More quirks in Obamacare: The same policy from the same insurer with the same coverage costs $1,800 per month in Virginia, but it costs only $285 in adjoining Maryland. This is because Maryland mandated that all policies cover, among other things, gastric by-pass surgery for obesity. Virginia did not, requiring those interested in that surgery to pay extra for that coverage.
Presumably, insurance companies–which are not allowed to charge extra for the $15,000 operation in Maryland–are having to make up the difference when selling policies elsewhere. I suspect that liberal states will be more generous in mandating coverage, with conservative states requiring fewer services unless consumers pay for them. That will mean people in liberal states will get more comprehensive health care coverage at a lower cost than those in conservative states, which will also have to foot the bill for the liberals’ generosity!
Consumers shopping for health coverage in new online marketplaces may scratch their heads when they come to a handful of plans in Virginia: Why do some cost more than $1,800 a month?
No, the plans do not include gold-plated hospital beds or guaranteed same-day access to doctors. Instead, those premiums reflect an add-on benefit for a type of costly surgery for obesity which makes them up to six times more expensive than plans without such coverage.
That means a Virginia consumer considering gastric bypass or bariatric surgery will have to pay up to $1,500 a month more for plans that cover the procedure.
Consumers in Maryland, by contrast, could buy any policy in the marketplace — and for dramatically less than the Virginia rider plans — and be covered for bariatric surgery because that state requires all plans to pay for it. In the District, insurers are not required to offer the surgical treatment, either as a rider or a standard benefit. The procedure can cost $15,000 to $25,000.
The difference between the approaches in Virginia and Maryland reflects some of the reasons for the broad variation in prices and benefits among policies offered under the federal health law.
Debates about how much to require insurers to cover and where to draw the line have long roiled state capitals as lawmakers are lobbied to mandate coverage of specific treatments or specialists. State laws vary, with some having fewer than 20 mandates and others, like Maryland, having more than double that number.Proponents see mandated benefit coverage as a way to protect consumers, while opponents say they drive up the cost of premiums for everyone, sometimes for questionable treatments pushed by special interests. Recent fights have included whether to require insurers to cover treatment for autism or in vitro fertilization. . . .
One mid-level policy from insurer Optima that covers the treatment, for example, is priced at $1,858 a month for a 27-year-old, but the same plan from the same insurer is $285 without the rider. Similar plans by other insurers, including Aetna, Coventry One and Innovation Health, range from $1,100 a month to $1,500, well above what the insurers charge for plans without the rider.
Under the health law, benefit packages must include 10 broad categories of care, including hospital coverage, maternity care, prescription drugs and mental health services. But states were given some leeway in choosing what else to include in that list. Along with Virginia, 27 other states chose benchmark policies that do not cover the surgery, according to an analysis by the obesity coalition. . . .
Some question whether Virginia insurers may be “adhering to the letter of the state law but not the spirit of the federal law,” said Deborah Chollet, a senior fellow at Mathematica Policy Research, a nonpartisan research firm in Washington.
That’s because the federal law says insurers cannot reject patients with medical conditions, nor charge them more, starting Jan. 1. Severe obesity is considered a disease, according to the American Medical Association.
“The health law says you cannot discriminate based on health conditions,” said John Morton, chief of bariatric and minimally invasive surgery at the Stanford University School of Medicine and president-elect of American Society for Metabolic and Bariatric Surgery. “Here they are adding a premium to a disease. It’s coverage in name only. It’s disgraceful.”
The legal arguments are not a slam dunk, though.
“You could make an argument that it is effectively discriminating . . . against someone who has a particular medical condition, but it’s clear under the law that insurers can charge extra for nonessential health benefits,” said Timothy Jost, a health law professor at Washington and Lee University. “If the state has determined this is not an essential health benefit, then you would have a hard time arguing it.”