The promise of the Affordable Care Act (ACA) was not just to broaden access to health insurance, but also to enable more Americans to have coverage they could count on if they became sick. The health law sought to ensure that coverage would meet the needs of consumers by requiring that insurance for individuals and small businesses include 10 categories of “essential health benefits.” In 2012, states helped determine the package of essential benefits that health plans in their state were required to offer starting in 2014. Though states recently had the chance to revisit this decision for 2017 and beyond, most stayed the course and will continue to define essential health benefits much as they had before.
States Revisit Insurer Benefit Requirements, But Have Little Data on Consumers’ Experiences – The Commonwealth FundNovember 2, 2015
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.”
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.
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.
Colonoscopy Screening after the Affordable Care Act: Cost Barriers Persist for Medicare Beneficiaries – AARPJanuary 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.
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.
Should the Affordable Care Act’s Preventive Services Coverage Provision Be Used to Widely Disseminate Whole Genome Sequencing to Americans?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.