Sunday, December 28, 2014

Using a cannon to swat a health insurance fly

When is health insurance not really health insurance? It is when your insurance company or employer can refuse to cover anything it feels like. And that was the danger in Sen. Roy Blunt's rejected amentment on the matter.

Using a cannon to swat a health insurance fly

When is health insurance not really health insurance? It is when your insurance company or employer can refuse to cover anything it feels like.

There was a time when physicians decided what care a patient needs. Now, it seems, lots of people want to have a say.

Sen. Roy Blunt (R., Mo.) recently introduced an amendment in the U.S. Senate that would let health plans and employers refuse to cover any item or service that is contrary to their “religious beliefs or moral convictions.” This could include almost anything.

The Senate rejected Blunt’s proposal on Thursday, but supporters promise to bring it back.

Blunt introduced his amendment, which would have been attached to an unrelated highway bill, in response to the Obama administration’s recently announced rule on coverage for contraceptives. The rule requires that most employees have access to such coverage, even those of some religiously affiliated organizations that oppose birth control, like Catholic hospitals and universities. However, employers who object to the coverage would not have to provide it directly, and actual houses of worship would be exempted entirely.

But the Blunt amendment would have applied well beyond the context of contraceptives and religious employers. It would have let even non-religious companies decline coverage for any medical product or service by citing a moral concern.

It’s not hard to imagine any number of essential treatments that could be cut from reimbursement. Drug and alcohol treatment, obesity management, smoking cessation, and vaccinations are examples of obvious targets, but there are many more.

In allowing easy coverage carve-outs, the amendment could have knocked the core out of health reform. The reform law would still have guaranteed access to coverage, but for some people that coverage could have been filled with holes.

Clearly, many of the amendment’s supporters would have reveled in the chance to chip away at the Affordable Care Act. However, the proposal was so broad that it might also have undermined coverage that some people enjoy today.

The purpose of health insurance is to provide a means of access to health care products and services that your physician feels you need. In most cases, the main constraints on coverage are that the items be recognized as part of accepted medical practice, that you truly need them, and that they are approved by regulators, like the Food and Drug Administration, if approval is legally required.

The role of your insurance company or employer should be to make that coverage available, not to decide in place of your physician what your medical needs are.

It’s not surprising that a number of national organizations representing physicians and patients spoke out against the proposal. They include the March of Dimes, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, and the American Cancer Society.

The Obama administration rule on contraceptive coverage stemmed from efforts to forge a compromise. It has so far met with strong approval from several Catholic organizations, including groups representing hospitals, universities and nuns. (See my blog post of Feb. 17.)

The Blunt proposal, in contrast, would have used a cannon to swat a fly. To protect some religious interests, it would have put all health insurance at risk.

If Blunt is serious about resolving the issue, he will instead seek to find a compromise between the competing interests involved. We should be looking for ways to expand health care coverage, not trying to take it away.


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About this blog
Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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