Preventive Care Mandate Debate

According to the Foundation for Health Coverage Education (FHCE), on September 23, the Patient Protection and Affordable Care Act will allow consumers who purchase new or revised insurance plans or policies to receive an array of preventive care services with no out-of-pocket cost. The Foundation cautions that this provision could instead lead to out-of-control medical costs, which will escalate insurance premiums.

Phil Lebherz, FHCE founder and executive director, specifically questioned the government's waiving the total cost to the consumer for smoking cessation, weight loss and alcohol treatment.  While he says preventative care should be considered as healthcare for calculating medical loss ratios, he says "free" preventative care is not free.

"When we pass mandates such as this one, whole industries show up to take advantage of the monies due them for consulting," he says. "This increases the cost of insurance. The folks that do not smoke or are not obese pay for the ones who are with no real benefit from the money spent. Also, the folks going to the consultants do not have any investment of their own in the behavior change in the form of money, so there is no real incentive to change. Insurance companies have tried this approach before and it failed and was continued in a form where co-pays and deductible were involved."

The new law will require that individual policies and employer-based health plans offer certain mandated preventive health care services with no out-of-pocket costs to Americans when they enroll in either new individual health policies or new group health plans, according to the Foundation. Consumers who keep their grandfathered plans and do not change their existing individual coverage or whose employer-based group plans are not changed considerably, will not be eligible for mandated services that have no out-of-pocket costs.

"What we’re trying to emphasize is that government has created a new set of mandates for insurers that provide the consumer with first dollar coverage and relieve them from any financial “skin” in the game; possibly resulting in higher recidivism rates," Lebherz says.

According to the Council for Affordable Health Insurance (CAHI) there are more than 2,000 mandated benefits. CAHI's studies show that mandated benefits could increase the cost of basic coverage from approximately 20% to as much as 50%, depending on the number and design of the benefits, as well as the initial cost of the premium.