19 Sep 2012

What health benefits do you think should be essential?

19 Sep 2012

It’s been almost two months since the Supreme Court upheld the Affordable Care Act (ACA), and we’re now beginning to have a a clearer picture of what health insurance will look like when major provisions take effect in 2014.

Under the ACA, essential health benefits must include services within 10 broad categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, 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).

The Health and Human Services department is charged with coming up with the specifics for the broad categories and has delegated that task to the states. As a result, California now has a major decision to make. The Wahington Post reports that “there is now legislation on Gov. Jerry Brown’s (D) desk that would benchmark California’s essential benefits to a small business plan offered by Kaiser Permanente.” The plan “includes the things you’d expect, like preventive care visits and hospital stays. It also has a few benefits you might not have seen coming like acupuncture. Acupuncture is “typically provided only for the treatment of nausea or as part of a comprehensive pain management program for the treatment of chronic pain,” but it is an included benefit in the Kaiser plan for a co-pay of $30 per visit. If the governor passes the legislation, acupuncture will become a standard benefit across private insurance plans.

There has already been significant support for the inclusion of acupuncture as an essential healthcare benefit reflecting a growing trend towards its popularity, backing by modern research, and a concerted effort by community outreach. But what about other benefits like massage, and chiropractic? As of right now, it doesn’t look like either one will be part of the essential health benefits here in California. Until lawmakers get final approval from the federal government we’re likely to see lobbying for other various health benefits. What are your thoughts? What benefits do you think should be essential?


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