At the Kathleen Sebelius Congressional Hearing on Obamacare, one Representative chided her that everyone in America was now being forced to purchase one standard benefit plan array that is mandated by the law. She explained that Americans don't like being told what to purchase; some like Fords and others like Mercedes. Also, some like crystal goblets and other drink out of red solo cups.
In fact, much of the turmoil that is now going on with millions losing health insurance coverage due to Obamacare is being caused by the need for all plans to meet the “10 Essential Elements” of the law. (About 17 million Americans purchase individual health insurance plans.) Plans that don't have these benefits cannot be offered and are being cancelled.
These required elements are:
Outpatient care—the kind you get without being admitted to a hospital
Trips to the emergency room
Treatment in the hospital for inpatient care
Care before and after your baby is born
Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
Your prescription drugs
Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
Your lab tests
Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
Pediatric services: This includes dental care and vision care for kids.
As a matter of a complete and comprehensive insurance policy, these elements are essential to some, but are often very expensive and not needed by others. This is the crystal goblet of health insurance.
For example, drugs can come to several thousand dollars a year for people with significant illnesses, while other are perfectly content with purchasing over the counter medicines for their occasional head ache. Should they be required to purchase drug insurance if they don't need it. Or should they subsidize the rest of the people who need pharmaceutical treatment?
In some insurance plans, maternity benefits can be carved out. Why would a couple in their 50s want the coverage? My son and his wife just had a premature birth costing well into six digits. Again, the same question: should the couple in their 50, or a single man or for that matter, anyone else who isn't likely to get pregnant be charged for this bill in their insurance premium?
Mental health services were also an option in many insurance plans, as the cost here can be crushing. Dealing with psychosis, bi-polar disorder, substance abuse often involves weekly sessions, long stays at rehab facilities and the treatment modalities vary significantly. Putting these services in a plan where everybody should share the cost drives premium prices skyward for everybody, not just the mentally ill.
Pediatric services speaks for itself, as single adults who don't plan on having kids often feel they shouldn't have to pay for some other parents' kids. But they are being forced to under Obamacare.
If you believe in the greater good, the spirit of socialism or the brotherhood of man, I suppose that all insurance plans offered in America should be one size fits all, except for deductible and co-pays. But just remember, for everybody getting a great plan for a small price due to having a pre-existing condition, being a large user of the medical services or getting a government subsidy, there is some family struggling to pay the new higher premium under Obamacare. It's a zero sum game. For those who get more than their money's worth, some body is getting less than they pay for.
So the sad lesson of Obamacare is: Nobody will be allowed to drink out of a red solo cup anymore.
(These situations don't occur as much in employer provided plans, as much of the premium is subsidized by the organization as they offer both single and dependent coverage. Generally, larger companies self-insure, so they they only pay the bills, and don't associate them with any specific individual, assuming anyone who works there is entitled to the insurance. Even if they purchase the insurance, it's a group contract.)
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