In a recent Wall Street Journal article, Scott Gottlieb, a physician and resident fellow at the American Enterprise Institute, highlights how one group, the United States Preventive Services Task Force (USPSTF), will have power over what Americans’ health care plans will and will not include.
Under Obamacare, the recommendations made by USPSTF will automatically determine which preventive health services are included by health insurance plans. The health law thus distorts the original intention of these otherwise perfectly reasonable recommendations by turning them into unreasonable requirements.
The USPSTF rates preventive services with grades A through D (or I for “insufficient evidence”), and under Obamacare, services with an A or B rating must be covered with no cost-sharing. The high cost of covering those services could cause those with ratings of C or D to be dropped from coverage. But many services that could be critical to specific patients are rated C or D, including screenings for breast and testicular cancer for certain age groups.
As Gottlieb warns, “The task force is also the only federal health agency to have the explicit legal authority to consider cost as one criterion in recommending whether patients should use a medical test or treatment.” As government’s role in health care expands, this could lead to patients being denied certain care partially due to cost.
Heritage expert Ed Haislmaier explains that insurers are also required to cover immunization recommendations from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and “preventative care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration” for women, infants, children, and adolescents. This particular provision of the law is the source of the highly controversial contraception mandate and its violation of religious liberty.
Last but not least, Obamacare gives the Department of Health and Human Services (HHS) the authority to set and annually update the “essential health benefits package,” which will outline the minimum benefits that all commercial and self-insured employer health plans must cover beginning in 2014. However, the benefits are loosely defined in the law, which states only that they shall include general categories and the items and services within those categories.
Ambiguous and evolving regulations provide an open invitation for special interest groups to lobby Congress for the never-ending expansion of the essential health benefit package. As more generous benefits are included, premium increases are guaranteed. And it doesn’t appear that HHS is planning to reveal what it intends that final package to look like anytime soon.
This slew of new mandates indicates that the government thinks it knows better than the patient when it comes to health care. As Gottlieb said, this is “a reminder that President Obama’s decision on contraception isn’t a one-off political intervention but the initial exploit of an elaborate new system.”