The Administration has been in a rush to issue regulations under the recent health law which emphasize “positive” aspects of the “reform”. The reason for the rush is obvious: this is a deeply unpopular law and it is already becoming apparent to people that the promises of lower costs were either untrue, and probably known to be untrue by the Administration and Congressional Democrats. The most recent set of proposed rules relates to coverage of preventive services. (HHS Draft Regulation) The health law said that preventive services must be covered without copays, coinsurance or deductibles. It left the details to HHS. The theory is that removing barriers to obtaining preventive care will save money by delaying or eliminating the risk of disease, or catching it’s presence earlier.
The proposed rules basically require coverage of preventive services recommended by various government task forces or bodies. The rules also create a confusing definition of when an office visit is or isn’t deemed to include preventive services, so that consumer cost-sharing can or can’t be applied, leading to new opportunities for provider and patient game-playing. Concern has been expressed that the rules will politicize the process of defining what is a necessary preventive services. A bigger concern is that there is little evidence that many preventive services are cost-effective or even actually delay disease. The proposed rules very misleadingly only refer as examples to the few preventive services, such as vaccinations, that have been shown to save money, without even acknowledging that the research finds that most increase health spending. Often screening and other services generate high numbers of false positives, which create anxiety for patients and generate even more health spending chasing a non-existent problem.
The fraud being emphasized by the Administration is that these services are being provided “free”. The draft of the rules, however, states the obvious: providing these services, especially without any payment from the patient will raise premiums. The Administration estimates the increase will be 1.5%, but it probably will be higher. And who will pay that increased premium? If recent history is any guide, it won’t be the employers, it will be the consumer who will see an increase in their share of the premium. So all consumers will see an increase in their insurance costs, in part to pay for preventive services of dubious value. Coupled with premium rises caused by other parts of the law, such as removal of lifetime caps and pre-existing conditions limitations, and you can see why people are starting to see that the new law will cause very significant increases in what they pay for health care. Regardless of what the best health benefit design may be, the leaders in any government have an absolute fiduciary obligation to be honest to the citizenry and taxpayers about what the cost of any change in the law will be. This Administration continues to fail to meet that obligation.