Health care reform

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. 

NEXT: Stephen Baldwin Arrested for Tax Evasion

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  1. …but as states finalize their benefits packages, it is becoming clear that what is received will depend partly on location.

    Well, at least you can’t say it’s one-size-fits-all. Fifty separate laboratories of lobbyist innovation.

    1. That much hasn’t changed, since state legislatures had always been in charge of that. What has changed is that the Death Star has now been added to the list of places rent-seekers go to get their mandates. And when you can centralize what had previously been 50 distinct operations, guess what is going to happen?

      1. The Kessel runs?

      2. Somebody finds an open ventilation shaft?

    2. “I have a BS in Lobbying Sciences.”

      1. meh. i’ve got an MA.

        1. And the puck flies over his head!

          1. no, it deserves to be mocked.

  2. Over all, the law requires that essential health benefits cover 10 broad categories, including… maternity and newborn care, …

    Oh, you’re infertile due to illness, injury or genetic defect? Well, maybe subsidizing the birth of strangers’ babies will make you feel better…

    1. You’re right, though I think it’s pretty tough to find a private health policy that excludes maternity bennies.

      1. I think many states require insurance companies to cover maternity and newborn care…

        1. That’s probably true. I’d like to see what the availability of non-maternity policies is in states that don’t mandate the coverage.

          1. It took all of 10 minutes to find my high-deductible HSA-compatible individual policy last summer in Michigan.

            A quick search gave me a few options to pick between. I spent more time going over the other minutiae than I did seeking out non-maternity. There was a maternity rider available with the plan I settled on, but it would’ve doubled the cost.

            My rate hasn’t gone up yet, but I suspect it’s just a matter of time.

    2. Being a guy is a genetic defect?

      1. Some would call it that. Do I really need to link to jezebel?

  3. maternity and newborn care

    Fuck that. People choose to have kids. They should pay for it themselves.

    1. Not in today’s world, my friend! Stealing from strangers via a proxy in the form of the violence monopoly known as government is the way to go! Make childless people pay for your little rugrat! Make young people pay for old people! Make healthy people pay for sick people! Make me pay for your hair implants! Make us all pay for Warty’s sexual predator rehabilitation treatment! It’s all good!

      1. I don’t believe for a minute that Warty is involved with any sort of rehabilitation treatment.

        1. It’s court-ordered.

          1. Hence why we’re paying for it, I guess.

            “Government is the great fiction through which everybody endeavors to live at the expense of everybody else.”

            – Bastiat (Possibly Episiarch in a previous life, when he was more erudite and eloquent, not to mention French)

            1. Episiarch in a previous life, when he was…. French

              I have had my disagreements with Epi in the past but this is just a low blow.

            2. Teah, rts. Over the line.

              1. Yeah, not Teah. I think it’s time to walk away from the computer. Maybe I’ll start making dinner?

              2. Payback for one time he called me “Canadian”.

                (That I am, in fact, Canadian, is beside the point…)

                1. Payback for one time he called me “Canadian”.

                  I fail to see that as an insult. I love you guys! Well, the Maritimes, New Brunswick and Newfoundland need to be annihilated. Sans PEI, of course.

                  Still not 100% sure what to do about Quebec…

                  1. Still not 100% sure what to do about Quebec…

                    Quebec has poutine. Keep it.

    2. Totally on board with this. It makes no sense for insurers to cover anything that has a substantial negative impact on someone’s health and is easily avoidable if desired. Most of them don’t cover cosmetic surgery because it’s elective. They don’t cover laser eye surgery because it’s elective. Why should they cover maternity? The species isn’t going to die out if government stops forcing non-reproducers to subsidize reproducers…

      1. If the government can require you to eat broccoli, it can require you to have children.

        1. Women sense my power and they seek the life essence. I do not avoid women, Mandrake. But I do deny them my essence.

        2. Insurance is supposed to be for unexpected events. If “I slipped and fell on his dick” doesn’t work in divorce court, it shouldn’t work here.

      2. I don’t think they should be forced to cover maternity. But possibly the reason is that it involves more than just the parents, it involves a little person who has no control over the health care he gets or has no means of paying for it, if his irresponsible parents can’t or won’t.

        Of course the people who advocate for free abortions talk out of both sides of their mouths on this point.

  4. I can’t think of a president who has been more praised for giving out corporate handjobs. Cash for Clunkers, the auto bailouts, Solyndra, Obamacare… I thought progressives were against crony capitalism?

    1. Perish the thought. Progressives are only opposed to the wrong kind of crony capitalism.

      1. Yes, progressives are 100% on board with crony capitalism of the fascistic variety. Any corporation in a line of business that meets what progressives view as the needs of the people, can easily be co-opted with the promise of government contracts, tax breaks, etc., as long as 1) lots of people are employed, and 2) a product or service is being provided to the public.

        1. and 3) progressives get to call the shots.

          1. “Tutto nello Stato, niente al di fuori dello Stato, nulla contro lo Stato!”

        2. 1) lots of union people are employed


    2. I thought progressives were against crony capitalism?

      Only when it involves war, wealth, and oil.


      1. Only when it involves war

        I guess we should be expecting a bunch of anti-war protests outside of the White House any day now.

      2. Scratch “wealth” off that list, Kevin. Southpaws are straining at the bit to lard up any number of fatcats that have declared their allegiance to Team Blue.

      3. I thought progressives were against crony capitalism?

        Only when the other team does it.

    3. What’s hilarious is that Tony – a supporter of every one of those things – frequently denounces us as corporate shills, even though we opposed all of them.

      1. There are corporations out there that haven’t been broken to the State bit, Jordan. Those are Bad Corporations. Good Corporations are those that are extensions of Democrat policy.

      2. But that’s only because we hate poor people.

        1. “But that’s only because we hate poor people.”

          Haha, yes…quite.

          /Polishes monocle with concentrated orphan tears.

    4. But Obama tsked tsked and shook his head when he did it. If those rascally corporations were more responsible he wouldn’t “have” to do it, see what they made him do?

  5. I had the opportunity to tour two hospitals in Kiev yesterday, and I must emphasize they are State-run hospitals, and the level of what would be laughingly care “care” was pretty fucking awful. I was horrified at what I saw. Fortunately, I am able to practice here strictly in private hospitals and clinics due to how medical law in the UKR is written currently.

    Normally, Katja Gorchinskaja is something of a proggie bedwetter WRT UKR politics (politics here are weird, and it’s difficult to give USA pols and personalities analogous to their UKR counterparts), but she was not exaggerating about Ohmadit Children’s Hospital. When I got back to my hotel, I cried for 15 minutes straight. I saw stuff that would never be tolerated in a country hospital, clinic, or even nursing home. I can’t get back to Donets’k fast enough.

    The NHS docs with whom I am here said flat out that the NHS’ primary mission is medical research and if the fruit of that research trickles down to the Proles, lovely. It’s not their primary goal. Also of note is UKR government is paying these NHS-ers to provide a higher level of care that UK denizens would hope or expect to receive at home.


    1. When I got back to my hotel, I cried for 15 minutes straight.

      I cried for 15 minutes straight.


          1. Thanks…saved me from reinventing the wheel.

  6. The point of this is that, with such “uneven” (read, “unfair”) care across the 50 states, the Federal government will “have” to step in to “equalize” care offerings.

    1. Posted yesterday:

      Rivkin and Casey: The Opening for a Fresh ObamaCare Challenge
      By defining the mandate as a tax, one that will not be uniformly applied, the Supreme Court ran afoul of the Constitution.

      ObamaCare provides that low-income taxpayers, who are nevertheless above the federal poverty line, can discharge their mandate-tax obligation by enrolling in the new, expanded Medicaid program, which serves as the functional equivalent of a tax credit. But that program will not now exist in every state because, as a matter of federal law, states can opt out. The actual tax burden will not be geographically uniform as the court’s precedents require.

      Thus, having transformed the individual mandate into a tax, the court may face renewed challenges to ObamaCare on uniformity grounds. The justices will then confront a tough choice. Having earlier reinterpreted the mandate as a tax, they would be hard-pressed to approve the geographic disparity created when states opt out of the Medicaid expansion. But that possibility is inherent in a scheme that imposes a nominally uniform tax liability accompanied by the practical equivalent of a fully off-setting tax credit available only to those living in certain states. To uphold such a taxing scheme would eliminate any meaningful uniformity requirement?a result that the Constitution does not permit.…..=Obamacare

  7. (cont.)

    I’m not suggesting that US medical care here will get quite that bad (even the Canuckistani doc here admits that wait times are bad in Canada), but when Tony sings his praises of centralized medical care, tell him to shove up his prolapsed asshole sideways chased with a saguaro cactus. With plenty of capsicum.

    To paraphrase Alan Grayson, “The RepublicanObamneyCare’s health care plan? Don’t get sick! Or die.”

    1. Your experience with government healthcare in the Ukraine mirrors mine in Brazil. My FIL was in a place that I wouldn’t take my dog to.

      1. Yes, and UKR has a relatively small population and ethnically speaking, fairly homogenous. And this was a country 25 years ago was as Commie as you can get with everything “free”.

        From what I understand, Russia is not much better, and they also use the centralized approach for the “free” State-run system, but private clinics and hospitals are available in the larger cities like Moskva and Santk-Peterburg. Some oblasti are more prosperous than others, like anyplace that practices Crony Capitalism.

        Care to weigh in, Tony? Care to defend your precious little NHS? Hmmmm?

        Just try and justify centralized planning, Soviet or even Limey style.

    2. It’s like Cassandra is screaming all around us about the horrors to come, and we just ignore her. Over and over again. Even though our Cassandra isn’t just some chick issuing dire warnings.

      1. Tell Cassie tits of gtfo.

        1. That’s what the Trojans said!

  8. “Individuals end up paying for benefits they neither need nor want.”

    Ummmm…..wasn’t that the whole point?

  9. Obama OKs Corporate $$ for Inaugural

    After the most expensive campaign in U.S. history, President Obama is dropping his principled objection to some forms of political fundraising to help pay for the post-election party.

    ABC News has learned that the Presidential Inaugural Committee will accept unlimited corporate donations to help fund Obama’s inauguration festivities next month, reversing a voluntary ban on the money he imposed on the inaugural four years ago and during the 2012 Democratic National Convention.

    I guess it wasn’t a “principled” objection, then? But at least they’re somewhat honest.

    Obama’s reversal is not the first time he has dropped self-imposed campaign financing rules meant to “change business as usual in Washington.” Earlier this year, Obama dropped his long-standing opposition to super PACs, giving his approval for top aides to support Priorities USA Action. During the 2008 campaign, he broke a standing promise to accept public financing for the general election.

  10. Earlier this year, Obama dropped his long-standing opposition to super PACs, giving his approval for top aides to support Priorities USA Action.

    Which, of course, is a gross violation of the legally required firewall between campaigns and “independent” SuperPACs, but we all know laws are for the little people.

  11. It too feel that maternal healthcare needs to be covered by the insurance companies as the availability of maternal policies needs to be made by the companies or may be made mandatory by the state.

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