Health insurers have to cover all benefits defined as essential to participate in insurance exchanges offering coverage to millions of additional consumers. The more treatments included, the higher the costs for those plans, said Roy Ramthun, director of federal affairs for the Council for Affordable Health Insurance in Alexandria, Virginia.
Quantifying the money at stake is difficult, “but when you look at how much is being spent on employer-provided benefits, I would think it would be hundreds of billions of dollars,” said Ramthun, whose organization represents small and mid-sized insurers.
Regulators issued rules in June letting insurers come up with a “reasonable interpretation” of essential benefits. Until the government “defines what those benefits are, health plans have to go by what they currently use,” said Robert Zirkelbach, a spokesman for the insurance industry’s main trade association, America’s Health Insurance Plans.
“The affordability question needs to be central to this discussion,” Zirkelbach said.
An HHS spokeswoman, Jessica Santillo, said agency officials can’t comment while regulations are under development.
UnitedHealth defines services and conditions such as diabetic supplies, pregnancy, drug abuse, tobacco cessation and limb prostheses as essential, its website says.
The insurer declared chiropractic care “non-essential,” along with services that cover acupuncture, infertility, hospice care and wigs. Tyler Mason, a spokesman for Minnetonka, Minnesota-based UnitedHealth, declined to comment in an e-mail.
The American Chiropractic Association, which says 87 percent of employer health plans cover its members’ services, has met with Congress and HHS officials since the law was enacted to urge the government not to follow UnitedHealth’s lead, said John Falardeau, the group’s vice president for government relations.
Americans spent about $3.9 billion out-of-pocket for chiropractic care in 2007, the latest available figures, according to the Centers for Disease Control and Prevention. Chiropractic is “typically covered” by employer-sponsored insurance, including the Blue Cross Blue Shield plan available to federal workers, as well as by Medicare, the U.S. health program for the elderly and disabled, Falardeau said. http://tinyurl.com/2w3c4v5