I argue that the provision of the Patient Protection and Affordable Care Act (ACA) of 2010, which eliminates cost sharing for preventive services, should be utilized as a pathway for reimbursing whole genome sequencing (WGS) and making it widely available to most Americans. This act provides multiple routes for determining which preventive services receive this designation. Three of these routes should be considered as pathways for reimbursing WGS, including approval by the United States Preventive Task Force, inclusion in the guidelines of the American Academy of Pediatrics Bright Futures Project, and classification as a preventive service for women by the Institute of Medicine. There are valid arguments against the expansion of this technology, including inadequate national and state laws prohibiting genetic discrimination, informed consent limitations, and potentially expensive genome interpretations. These concerns should not inhibit the wide dissemination of this technology, as current efforts by NIH and industry to expand the use of genome sequencing demonstrate. The Affordable Care Act should be used as a tool to prevent disparities in access to genome information in the United States and avoid the development of a two-tiered health system based on those with and without genome sequence data.
Should the Affordable Care Act’s Preventive Services Coverage Provision Be Used to Widely Disseminate Whole Genome Sequencing to Americans?November 25, 2013
Perry Payne argues that the health care system should encourage provision of whole genome sequencing (WGS) for most people in the near future. Payne\’s essay contains two distinct claims. One claim is that near-universal access to WGS would be beneficial both to individuals and to populations who, without it, could be on the losing end of widening health disparities. The second claim is that the preventive services provisions of the Patient Protection and Affordable Care Act (ACA) should be invoked to establish legal entitlements to WGS, without any patient cost sharing. We believe there are strong reasons to reject both of these claims. Indeed, the reasons that count against providing wide access to WGS are the very same reasons that undermine Payne\’s argument for providing WGS under the preventive services provisions of the ACA.
As it happens, the essential health benefits requirement is one the worst aspects of Obamacare, at least for those who think greater innovation is needed to improve US healthcare quality, affordability, and accessibility.
The Catholic Health Association (CHA) today issued a memorandum for its members regarding the final rule on the controversial contraception mandate ordered by the Department of Health and Human Services. Essentially, CHA believes the combination of exemptions and accommodations within the mandate are sufficient.
Voice and Exit in Health Care Policy
What can we learn from the recent controversy
over mandated birth control coverage?
By M. Todd Henderson
Obamacare is designed to destroy the insurance market. Markets do not function without prices, and Obamacare ensures that prices will not be allowed to emerge. There is a medical price associated with smoking, but the District of Columbia has decided to suppress that price by law. Pretending that smoking has no relationship with health-care costs does not make it so — it is only a way to push costs around in a way that is agreeable to the likes of Barack Obama, converting a system that prices risk into a system of entitlements.
After nearly a century of failed or incomplete legislative efforts, the Patient Protection and Affordable Care Act (PPACA), enacted by Congress in March 2010, establishes the principle that every American is entitled to affordable and effective health insurance coverage regardless of income or health status. Although many aspects of the act have received broad attention, its impact on reproductive health has received considerably less scrutiny, except when debated through the specific lens of particularly polarized ideological concerns. If fully implemented as planned, the PPACA has the potential to improve reproductive health in the United States in at least three ways: increasing the number of women and men with insurance coverage; increasing the value of insurance coverage for addressing reproductive health needs; and improving access to reproductive health services and information more generally. Several PPACA provisions stand out as having particular importance for reproductive health, including Medicaid family planning expansions, standards for an essential health benefits package, expanded coverage for contraception and other clinical preventive services, and teen pregnancy prevention programs. All these potential gains, however, are threatened by political, economic, and logistical challenges to the PPACA and by flaws in the legislation itself.
There’s mounting evidence that come fall, the health plans sold through the Obamacare exchanges will be bare bones affairs – with narrow networks of providers to select from, and heavy co-insurance once patients go “out of network.”
In many ways these plans will be a throwback to insurance schemes of the late 1990s, when managed care was dominant and restrictive networks standard fare.
With one difference: The Obamacare plans won’t be cheap.
Insurers must cover 10 broad categories of care, including emergency services, maternity care, hospital and doctors’ services, mental health and substance abuse care and prescription drugs.
Essential benefit requirements apply to individual and small group plans sold within and outside the new online, state-based exchanges scheduled to launch in 2014. The requirements also apply to benefits provided to those newly eligible for Medicaid coverage. These requirements do not apply to self-insured health plans, which is how most large companies cover their employees.
Trends and Characteristics of Preventive Care Visits Among Commercially Insured Adolescents, 2003-2010 by Yuping Tsai, Fangjun Zhou, Pascale Wortley, Abigail Shefer, Shannon Stokley :: SSRNFebruary 20, 2013
Background: The proportion of adolescents making an annual preventive visit has been considerably low compared with infants and children. During 2005 and 2007, the Advisory Committee on Immunization Practices (ACIP) recommended three vaccines targeted at this age group. One potential benefit of these recommendations is that they could increase the number of outpatient visits in which other clinical preventive services could also be provided. This study examines the time trend in preventive visits by commercially insured adolescents during 2003-2010.
Methods: We use data from the MarketScan database. Our study population includes adolescents aged 11 to 21 continuously enrolled in the same insurance plan during the calendar year. We calculated the annual proportion of adolescents with at least one preventive and one vaccination-related visit. Longitudinal analyses were conducted by following individual enrollees for 8 consecutive years.
Results: The proportion of adolescents making at least one preventive visit increased from 24.7% to 41.1% during 2003-2010. The rate of vaccination-related visit increased from 12.3% to 26.4%. The magnitude of the increase in preventive and vaccination-related visits was greater during the years in which ACIP issued recommendations. The rates of preventive and vaccination-related visit were higher among female and young adolescents and adolescents in managed care insurance plans. Longitudinal analyses indicated that 2.4% of adolescents had a yearly preventive care visit during the 8 years.
Conclusions: Our findings provide suggestive evidence that ACIP recommendations might have improved the preventive visit rate of adolescents, implying that vaccine recommendations might result in additional benefits for adolescents.