‘Skinny’ Health Plans Might Not Be So Skinny

One of the ideas that surfaces in discussions to replace the ACA is to allow health insurers to not cover some of the services that the law currently makes them cover. Opponents of Obamacare call them skinny plans. But as the Wall Street Journal reports today, that might not really amount to much in the way of savings for beneficiaries.

The newspaper touched base with Larry Levitt, a senior researcher with the Kaiser Family Foundation. “The large bulk of costs under an insurance policy are doctors, hospitals and drugs,” he said. “It’s hard to imagine a reasonable insurance policy that doesn’t include those benefits.”

According to CMS, the 10 mandated coverage categories are:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Opponents of the ACA “often cite maternity care and mental health treatment as examples of items that drive up costs for people who don’t need those specialty services,” the Wall Street Journal reports. But the newspaper cites a Milliman study that says that maternity care takes up just 3.4% of insurance costs. The cost for mental health services, including addiction treatment? Just 4.2%.

Source: Wall Street Journal