April 17, 2014
Access to preventive care at no charge to the patient is a key tenet of the federal health law. But questions about what qualifies as “preventive” are causing discord between doctors and patients, particularly when it comes to the traditional annual checkup.
Some patients, anticipating free visits to address all their health issues—past, present and potential—are upset to find that only some of that qualifies as preventive care, exempt from deductibles and copays.
“Patients are scheduling ‘physicals’ because physicals are free,” says Randy Wexler, a family-medicine physician in Columbus, Ohio. “But they come in and say, ‘I’ve been having headaches. My back has been bothering me and I’m depressed.’ That’s not part of a physical. That will trigger a copay.”
via Discord Over Doctors’ Bills and What Is Considered ‘Preventive’ – WSJ.com.
February 26, 2014
With the release of the new Affordable Care Act health plans, HealthPocket examined what medical services were most frequently excluded from health insurance coverage in 2014 and compared the results to the most common exclusions in the pre-reform health insurance market. HealthPocket found that 80% of exclusions were the same between the 2013 and 2014 lists of medical services most frequently not covered by plans in the individual health insurance market.
via Top 10 Healthcare Services Excluded Under Obamacare – Healthpocket.
February 12, 2014
One of the largest and most meticulous studies of mammography ever done, involving 90,000 women and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age.
It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation.
via Vast Study Casts Doubts on Value of Mammograms – NYTimes.com.
January 29, 2014
The Affordable Care Act (ACA) sought to address low rates in the use of recommended preventive services—including colonoscopy—by partially eliminating Medicare beneficiary cost sharing. Beneficiaries continue to be exposed to costs if polyps are found and removed, if tissue is biopsied during the procedure, or if the colonoscopy is administered following a stool blood test indicating that cancerous cells might be present in the colon. These remaining costs could be a barrier to the use of this lifesaving test. This report discusses these barriers and presents policy options that may help overcome them.
via Colonoscopy Screening after the Affordable Care Act: Cost Barriers Persist for Medicare Beneficiaries – AARP.
December 17, 2013
The Affordable Care Act mandated that insurers cover dental care for children. Indeed, it was one of the 10 essential health benefits meant to set the bar for adequate health insurance.
But pediatric dental care is handled differently from coverage of other essential benefits on federal and state exchanges. These plans are often sold separately from medical insurance, and dental coverage for children is optional. People shopping on the exchanges are not required to buy it and do not receive financial support for buying it.
Now experts are warning that the flawed implementation of this benefit on the exchanges could leave millions of children without access to dental care.
via A Gap in the Affordable Care Act – NYTimes.com.
November 25, 2013
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.
via 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.
via Why We Should Not Use the Affordable Care Act to Encourage Widespread Whole Genome Sequencing.