My 2013 editorial perfectly illustrates the problem of special interest lobbying to include mandates that people don’t need or want. Why should adults without children be forced to buy pediatric vision and dental coverage?
An Invitation to Special-Interest Lobbying. As experience with insurance benefit mandates at the state level shows, providers and patient groups can be expected to exert pressure on HHS and Congress to expand the scope of the federal minimum coverage requirements. To the extent that HHS or Congress bows to that political pressure, health insurance premiums will escalate still further after 2014. Shifting that dynamic from state governments to the federal government means that the cost of coverage will increase significantly in those states that have so far successfully resisted provider lobbying for benefit mandates. In addition, self-insured employer plans will no longer be exempt from benefit mandates. Unlike state laws, the new federal benefit mandates will apply to both commercial insurers and self-insured employer plans
by Lisa Shin
Imagine there is a new law in the land. Everyone has to purchase an infant car seat. Already have one? Don’t have kids? Don’t have a car? Can’t afford it?
Sorry, you can’t opt out of this one. The intent of the law was to provide a car seat for those who couldn’t afford it. Law advocates feared that a child might get missed, if car seats were made optional. There was a “collective gasp” at the possibility of parents having the choice to “opt-out” of this life-saving device. The cost estimate of pennies per person turned into a total cost of many billions, due to the cost of implementation.
The good idea had many disastrous consequences, such as massive debt, increased taxes and unemployment, but alas, it was too late to reverse it.
In the Exchanges, every qualified health plan (QHP) will be required to cover pediatric benefits, oral and vision. Since most health plans lack a pediatric vision benefit, 45 states will use benefits from the Federal Employee Dental and Vision Insurance (FEDVIP) plan or the Children’s Health Insurance Plan (CHIP). Sounds great, huh?
Except that such benefits go far beyond typical small group and individual health plans and will lead to more expensive coverage costs for both employers and individuals. This clearly illustrates one of the many flaws in the Affordable Care Act. “Obamacare” requires health plans to cover whatever benefits are deemed essential by the Secretary of Health and Human Services.
As Heritage expert Ed Haislmaier explains, “The new federal benefit requirements represent a blatant assertion that Congress and federal bureaucrats know best how to design health insurance policies. The effects will be one-size-fits-all coverage — so that patients are not ‘confused’ by having choices — and elimination of employers’ freedom to design their own self-insured plans.”
Special-interest groups will most certainly lobby for inclusion of generous benefits, and the more expansive the ‘essential benefits’ package becomes, the more it will cost. The coverage ‘floor’ will become the ceiling and Americans will have fewer options.
You might argue that the cost will be lower for health plans where pediatric benefits will not be utilized. True enough. Health insurers should offer less expensive plans to childless adults, but they are not required to do so. The danger here is that for those who are not eligible for our taxpayer-funded subsidies, health insurers are more likely to offer lower premiums for benefits not utilized. But for those who are eligible for subsidies, insurers would offer a plan based on cost of required essential benefits, regardless of whether they were utilized.
You might argue that spreading the cost across more people will decrease the cost of the pediatric vision benefit. However, vision plans are optional, supplemental and voluntary in the current market. The cost of a vision plan remains roughly the same, regardless of the number of those plans.
You might argue that the long-term cost-savings of pediatric vision care outweigh the short-term increased cost. Of course, early detection and treatment of eye problems can have long-term benefits for a child’s development, education and indeed overall health. However, mandating every health plan to cover a pediatric vision plan is costly, inefficient, and unsustainable. There are two better ways:
1. Allow stand-alone vision plans, such as VSP, to “satisfy” the pediatric vision requirement. Allow those without children to opt-out of the pediatric vision benefit. Allowing this “opt-out” would lower premiums for those without eligible children, those with adult children and those who could not afford the additional cost.
2. Allow health insurers to use vision screenings to identify those children with eye problems. Vision screenings for all infants and school-age children provide widespread, highly accessible and cost effective testing.
The American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and American Academy of Pediatrics recommend screening for the early detection and treatment of eye problems.
Screenings can be highly effective and accurate, while minimizing unnecessary referrals and cost. The screener should not have a vested interest in the screening outcome. With a failed screening report, parents could then apply for a vision plan to cover a comprehensive eye examination and eyeglasses.
Children could receive further medical and surgical care if necessary.
HHS rejected both cost-saving measures.
Why are we surprised at the skyrocketing of health insurance premiums? It is inevitable when we have a law that isn’t just asking you to pay for the services that you are going to consume. The mandate is forcing you to subsidize services that will be received by somebody else.
Lisa Shin has an optometric practice in Los Alamos.