Essential Benefits or Health Industry Handouts?


ObamaCare lays out 10 categories of "essential benefits" that health insurers in the individual market must cover under the law. But in regulations published in the wake of the law's passage, federal authorities left states a fair amount of leeway to determine which services, exactly, will meet the law's broad criteria for essential benefits.

So how do state officials determine which health benefits are truly essential parts of a person's health insurance coverage? In part by listening to health industry interest groups. Who are not, shall we say, entirely objective observers. Earlier this week, The New York Times noted the push by interest groups like chiropracters and acupuncturists to ensure that their services were required by law. 

Most of the roughly two dozen states that have chosen their essential benefits — services that insurance will have to cover under the law — have decided to include chiropractic care in their package. Four states — California, Maryland, New Mexico and Washington — included acupuncture for treating pain, nausea and other ailments. It is also likely to be an essential benefit in Alaska and Nevada, according to the Department of Health and Human Services.

"To me, six is huge," said Ms. Kang, an acupuncturist in Los Angeles, who helped coordinate the lobbying effort.

The main goal of the health care law has always been to guarantee medical coverage to nearly all Americans, but as states finalize their benefits packages, it is becoming clear that what is received will depend partly on location.

According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in Massachusetts, but not in Arizona.

Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state.

ObamaCare's individual mandate wasn't simply a requirement that most everyone get some kind of health insurance. It was a requirement that most everyone that get health insurance that meets certain criteria defined by federal and state authorities. Inevitably, that means that health care providers end up lobbying to be included in those criteria. And in many cases that will mean that individuals end up paying for benefits they neither need nor want.