Tags: Chiropractic | Autism | Care | Essential | Under | Obama | Law

Chiropractic, Autism Care May Be Essential Under Obamacare

Friday, 22 October 2010 01:47 PM

Chiropractic care is covered by an estimated 87 percent of employer-sponsored health plans. Whether it’s necessary for all Americans is a question now shaping the healthcare overhaul.

The health law passed in March requires that insurers led by UnitedHealth Group Inc. and WellPoint Inc. begin covering a package of “essential benefits” in 2014. The law doesn’t say what care should be included, leaving that up to the U.S. Department of Health and Human Services. That, in turn, has spurred a lobbying push by advocacy groups for chiropractic care, autism treatments and dozens of therapies.

Health insurers will have to cover all benefits defined as essential to participate in insurance exchanges that will offer coverage to millions of additional consumers. The more treatments included, the higher the costs for those plans, said Roy Ramthun, director of federal affairs for the Council for Affordable Health Insurance in Alexandria, Virginia, which represents small and mid-sized insurers.

Quantifying the money at stake is difficult, Ramthun said, “but when you look at how much is being spent on employer- provided benefits, I would think it would be hundreds of billions of dollars.”

Regulators issued rules in June letting insurers come up with a “reasonable interpretation” of essential benefits. Until the government “defines what those benefits are, health plans have to go by what they currently use,” said Robert Zirkelbach, a spokesman for the insurance industry’s main trade association, America’s Health Insurance Plans.

‘Affordability Question’

“The affordability question needs to be central to this discussion,” Zirkelbach said.

An HHS spokeswoman, Jessica Santillo, said agency officials can’t comment while regulations are under development.

UnitedHealth defines services and conditions such as diabetic supplies, pregnancy, drug abuse, tobacco cessation and limb prostheses as essential, according to its website.

The insurer declared chiropractic care “non-essential,” along with services that cover acupuncture, infertility, hospice care and wigs. Tyler Mason, a spokesman for Minnetonka, Minnesota-based UnitedHealth, declined to comment in an e-mail.

The American Chiropractic Association, which says 87 percent of employer health plans cover its members’ services, has met with Congress and HHS officials since the law was enacted to urge the government not to follow UnitedHealth’s lead, said John Falardeau, the group’s vice president for government relations.

Chiropractic Costs

Americans spent about $3.9 billion out-of-pocket for chiropractic care in 2007, the latest available figures, according to the Centers for Disease Control and Prevention. Chiropractic is “typically covered” by employer-sponsored insurance, including the Blue Cross Blue Shield plan available to federal workers, as well as by Medicare, the U.S. health program for the elderly and disabled, Falardeau said.

The Wisconsin Chiropractic Association has created a website with sample letters that practitioners, patients and employers can send to lawmakers. The group is concerned that insurers will stop covering chiropractors’ services if “neuromusculoskeletal care” isn’t declared essential, Russ Leonard, executive director of the group, said by telephone.

Coverage is still to be determined on “behavioral health” services, which are a concern for people with autism and their families, said Stuart Spielman, senior policy adviser and counsel for the advocacy group Autism Speaks in Washington.

‘Very Poor Care’

Insurance coverage for autism services vary from state to state, with people with the condition often getting “very poor care,” he said by telephone. Spielman’s 16-year-old son has autism.

Medical costs for people with autism are four to six times greater than for those without the condition, the Atlanta-based CDC estimates. Twenty-three states have adopted laws requiring insurers to cover screenings, therapy and related services, according to Autism Speaks.

Lifetime treatment for autism costs about $306,000, Michael Ganz of the Harvard University School of Public Health estimated in a 2007 report that didn’t distinguish between severe or mild forms.

Autism advocates are lobbying the government to interpret language in the law requiring coverage of “behavioral health” services to include autism treatment.

Advocates for people with physical disabilities tried unsuccessfully to get language in the law to cover home medical equipment, orthotics and prostheses, said Peter Thomas, a lobbyist with the firm Powers Pyles Sutter & Verville who is chairman of the Consortium of Citizens with Disabilities’ health task force. The law requires coverage of “rehabilitative and habilitative services and devices” and doesn’t elaborate.

‘Cutting-Room Floor’

“It wound up on the cutting-room floor,” Thomas said of his group’s effort.

He’s trying to persuade the National Association of Insurance Commissioners to include equipment such as prostheses and orthotics among definitions of medical terms and insurance standards it plans to recommend to the government. The commissioners have no position on the issue, Erin Johnson, a spokeswoman, said by e-mail. The group doesn’t expect its recommendations to be used to define essential benefits, Thomas said.

“It’s probably the most critical issue before the disability community now,” said Thomas, who has two artificial legs, the result of a car accident when he was 10 years old.

Surveying Insurance

The Labor Department is required to start the process under the law by surveying employers’ insurance to determine typical coverage.

“There’s no evidence that the initial phase of essential benefits development has even started,” said Falardeau, the chiropractor’s association spokesman.

Two phone messages left with the department’s public affairs office weren’t returned, and neither were e-mails to spokeswomen Gloria Della and Dolline Hatchett.

“If you cover a broader range of essential services, the cost of the benefit package is going to be higher,” Mark McClellan, who led the Centers for Medicare and Medicaid Services under former President George W. Bush and is now a researcher at the nonprofit Brookings Institution, said in a telephone interview.

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Friday, 22 October 2010 01:47 PM
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