Insurers will pick up preventive care costs under new rules

Jul 16 2010

The recommendations of a federal task force on preventive care - once just suggestions for doctors - will soon become coverage requirements for private insurers under regulations unveiled Wednesday by the Obama administration, according to Kaiser Health News and The Washington Post. "Under the new health care overhaul law, insurers will be required to pay fully for services that get an "A" or "B" recommendation from the U.S. Preventive Services Task Force, a volunteer group made up of primary care and public health experts." But, it will also open the door to lobbying and advocacy by disease groups, physicians and companies that have an interest in seeing services covered. That may create conflicts for the scholarly group that has so far endeavored to avoid the political process (Weaver, 7/15).

The New York Times: "The new requirements promise significant benefits for consumers — if they take advantage of the services that should now be more readily available and affordable. ... The rules will eliminate co-payments, deductibles and other charges for blood pressure, diabetes and cholesterol tests; many cancer screenings; routine vaccinations; prenatal care; and regular wellness visits for infants and children." The cost of the changes will by an increase of about 1.5 percent for insurance premiums, the administration estimates. The changes would go into effect for plans beginning after Sept. 23 (Pear, 7/14).

The Wall Street Journal: "The regulations don't address a different slate of covered preventive services for women, which won't be determined until August 2011. The Planned Parenthood Federation of America is pushing for birth control to be included in that segment of the regulations. Screenings for HIV and several other sexually transmitted diseases qualify as free preventive care under the guidelines released Wednesday" (Adamy, 7/15).

Related, earlier KHN story: Preventing Pregnancy: Should Patients Get Contraceptives From Health Plans At No Cost? (Andrew, 7/6)

The Associated Press: Under the regulations laid out Wednesday, insurers will have to pick up the full tab for "[r]outine vaccines from childhood immunizations to tetanus boosters for adults." Those suggestions come from the Centers for Disease Control and Prevention. They would also have to cover "[w]ell-baby visits to a pediatrician, vision and hearing tests for children, and counseling to help youngsters maintain a healthy weight. These and other services are recommended under guidelines developed by the government and the American Academy of Pediatrics" (Alonso-Zaldivar, 7/15).

"What about mammograms?" the Los Angeles Times asks. The last time the U.S. Preventive Services Task Force made headlines was over a controversial guideline released in November that recommended most women wait until age 50, rather than 40, to begin getting routine breast cancer screeningss. "But lawmakers inserted a provision in the new law specifying that women older than 40 will still be able to get a mammogram screening every year or two at no cost" (Levey, 7/15).

Reuters: "A spokesperson for America's Health Insurance Plans, an industry group for health insurance companies, said the rules did a good job of expanding access for preventive services, while keeping coverage affordable. ... It is unclear what effect the rules will have on insurers, [AHIP's Robert] Zirkelbach said. Eliminating co-payments could shift that cost to the premiums and the expanded coverage also does not apply to all insurance plans. Under the healthcare overhaul law, many 'grandfathered' plans are exempt from the rules."

"Only new plans or those that significantly cut benefits or raise costs will be affected, although more and more plans are expected to lose grandfather status each year. Other prevention efforts will go into effect next year. Medicare patients will have access to free prevention services, including annual wellness visits. State Medicaid programs will also cover programs aimed at getting pregnant women to stop smoking" (Lentz, 7/14).