Provisions of the Affordable Care Act require health insurance in all states to cover at least ten broad categories of health care. Doctor appointments, maternity care, and prescription drugs are among required benefits. In addition, state officials must use an existing health plan as a template upon which to base standard coverage.
The packages being selected by state officials look pretty similar for standard doctor and hospital care, but a lot of variety is appearing when it comes to what’s often referred to as alternative treatments. As you can imagine, a multitude of special interests are lobbying to make sure that their preferred treatment be part of the mandated coverage. The more successful they are, the more expensive coverage will be.
For instance, an advisory board for the Virginia health insurance exchange wants to include chiropractic services and speech therapy in mandated coverage. In California, the legislature agreed to include acupuncture as an essential health benefit, while other states, like Oregon, have already ruled out including acupuncture, chiropractic services and fertility treatment.
Oregon officials have also excluded bariatric surgery and other stomach-reduction procedures. Instead, they want to focus on preventing obesity. Coverage for mental health services is likewise less than uniform among the states.
In some states, there remains disagreement over whether to define a benchmark policy at all. The alternative is to rely on the federal government. In that case, the benchmark will default to match the largest small-group plan offered in the state.
What will happen if state officials try to set a benchmark that fails to meet federal requirements? We’ll have to see how that turns out because Utah officials have already upset advocacy groups by defying one federal mandate. They’ve approved a policy without coverage for substance abuse treatment, which is at odds with federal requirements. Advocacy groups are also alarmed because beginning dental coverage at age three may not be in line with federal requirements to cover pediatric dental care.
There are going to be a lot a “growing pains” between now and next October when the state exchanges are scheduled to be available over the Internet. We’ll follow the news to keep you informed about what’s happening in your state and what it may mean for your future health care.