Affordable Care Act: State Rules Can Boost Costs
Maryland chose a benchmark plan that does require coverage, reflecting its longstanding law. A Maryland Health Care Commission report from last year estimates the state’s mandate to cover treatment for severe obesity added about 0.4 percent to the cost of an individual health policy, far below the 600 percent differential seen in some of the plans with riders in Virginia.
Maryland Plans ‘More Affordable’
In states like Maryland where the cost of surgical treatment for obesity is included in all plans, the premiums are “more affordable than the Virginia plans with the add-on bariatric coverage, which drives up the price for those specific plans,” said Aetna spokeswoman Cynthia Michener.
Some question whether Virginia insurers may be “adhering to the letter of the state law but not the spirit of the federal law,” said Deborah Chollet, a senior fellow at Mathematica Policy Research, a nonpartisan research firm in Washington.
That’s because the federal law says insurers cannot reject patients with medical conditions, nor charge them more, starting Jan. 1. Severe obesity is considered a disease, according to the American Medical Association.
“The health law says you cannot discriminate based on health conditions,” said John Morton, chief of bariatric and minimally invasive surgery at the Stanford University School of Medicine and president-elect of American Society for Metabolic and Bariatric Surgery. “Here they are adding a premium to a disease. It’s coverage in name only. It’s disgraceful. “
The legal arguments are not a slam dunk.
“You could make an argument that it is effectively discriminating ... against someone who has a particular medical condition, but it’s clear under the law that insurers can charge extra for non-essential health benefits,” said Timothy Jost a health law professor at Washington and Lee University. “If the state has determined this is not an essential health benefit, then you would have a hard time arguing it.”
While state mandates vary, Virginia’s laws around bariatric surgery for obesity are “kind of an anomaly,” said Steve Cindrich, director of strategic marketing and business development at Optima, an insurer owned by hospital system Sentara.
Fri, Oct 11 2013