What Will ObamaCare Cover?
What is medically necessary? Who decides?
Decide if your tax dollars should cover:
Needle exchanges for heroin addicts
Smoking cessation treatments and programs
SSRIs (such as Prozac) for “normal” people
who want to feel “better than normal”
Physician assisted suicide
LMNA and IGF-1 to lengthen life
Pre-implantation genetic diagnosis of embryos
Surrogate mother fees
Sperm bank fees
Storage fees for unwanted embryos from IVF attempts
Bariatric surgery (stomach stapling)
Weight loss foods and supplements
Gym memberships and tennis shoes
Mammary enhancement or reduction
Eye-rounding for people of Asian descent
Should people be required to allow their bodies to be harvested for organs?
Should bull riders and parachutists get full coverage at standard prices?
Are people responsible for their obesity or heart disease?
Medical necessity will be determined by an agency designated by the government, whose values may be radically different from yours. The definition will change based on political tussles and budgets. You may pay for things you consider patently abhorrent, or for things that you consider to be the responsibility of the patient, self- inflicted.
Some people consider naturopathy, acupuncture, vitamin and chelation therapy, and herbal remedies spurious. Do you? The critical question is: does the government? Will the government change it’s mind? (Yes.) Whatever Congress or the President’s regulator decides is what you will pay for, all haggled out in a rancorous, public, manipulated process.
Baucus Bill Covers:
This is all I could find in the 223 page summary of the Baucus bill to answer my question if ObamaCare will cover stomach stapling, breast enlargement, sex-change operations, physician assisted suicide, needle exchange, and other treatments that many will find objectionable, not cost effective, or the responsibility of the individual:
Federal law does not define a minimum creditable coverage (MCC) benefit package for purposes of individual (individual), small group (employers with 2-50 workers (1-50 in some states) or up to 100 in some states), and other group private health insurance. States have the primary responsibility of regulating the business of insurance and may define what qualifies as minimum creditable coverage. However, Federal law requires that private health insurance include certain benefits and protections. HIPAA and subsequent amendments require, for example, that group health plans and insurers cover minimum hospital stays for maternity care, provide parity in annual and lifetime mental health benefits, and offer reconstructive breast surgery if the plan covers mastectomies.
Definition of Four Benefit Categories. Four benefit categories would be available: bronze, silver, gold and platinum. No policies could be issued in the individual or small group market (other than grandfathered plans) that did not meet the actuarial standards described below. All health insurance plans in the individual and small group market would be required, at a minimum, to offer coverage in the silver and gold categories.
All plans must provide preventive and primary care, emergency services, hospitalization, physician services, outpatient services, day surgery and related anesthesia, diagnostic imaging and screenings (including x-rays), maternity and newborn care, pediatric services (including dental and vision), medical/surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services that at least meet minimum standards set by Federal and state laws. In addition, plans could charge no cost-sharing (e.g., deductibles, copayments) 18
for preventive care services, except in cases where value-based insurance design16 is used. Plans could also not include lifetime limits on coverage or annual limits on any benefits. Any insurer that rates on tobacco use must also provide coverage for comprehensive tobacco cessation programs including counseling and pharmacotherapy (prescription and non-prescription). The provisions in this paragraph would all be within the actuarial value of the appropriate benefit level.
Filed under: Politics