To me, the idea that the essential health benefits (EHB) package could actually require health plans to cover acupuncture, chiropractic care and even adult hearing aids seems pretty shocking.
Robert Cosway talks about variations in the various plans states are supposed to use as EHB benchmarks in a paper on the Patient Protection and Affordable Care Act (PPACA) EHB program.
Starting in 2014, all major medical medical plans sold through the PPACA exchange system are supposed to cover a state's EHB package, and carriers are supposed to determine whether a plan they offer is at the platinum, gold, silver or bronze "metal level" by calculating how much of the actuarial value of the EHB package the plan covers.
The benchmark candidate plan benefits packages don't really differ all that much within states or from state to state, but they do differ significantly in terms of six types of benefits, Cosway said.
To me, questions about what kinds of services plans should cover for children with autism and how much physical and occupational therapy the EHB package should include seem reasonable. I don't know what the right answer is, but those types of benefits are widely accepted treatments for people who obviously have serious problems.
Coverage for hearing aids for adults who aren't poor seems much more questionable. Why should moderate-income workers pay for high-income workers' hearing aid benefits? I think the idea that the EHB package could include this benefit is absurd But at least a hearing aid is a well-understood, well-tested kind of machine that helps people with ear problems cope with ear problems. I can understand why we're talking about that.
Debating whether to cover artificial reproduction therapies, such as in vitro fertilization, seems way, way more out there. But, on the other hand, that kind of therapy is a way that some people can cope with a serious physical difference. I think imposing an in vitro fertilization benefits mandate in the EHB package would be absurd, but I can grasp why others might think differently. Maybe the cost will come down, and the number of super-twins born will go down.
But the idea that we're even thinking about requiring the EHB package — the basis for health benefits that the government would be subsidizing for many — cover acupuncture and chiropractic care seems pretty absurd. That kind of debate seems to be driven more by alternative care practitioners' lobbyists than any kind of serious interest in providing a decent level of health care for all.
The experimental evidence that those types of care work seems weak, and who has ever died or lost a limb due to lack of acupuncture or chiropractic care?
Some of my most intelligent, most passionate readers really oppose any significant government intervention in the ordinary acute health care insurance market.
