One of the distinct features of health policy that distinguishes it from, say, foreign policy, is the wide variety of policymakers involved in making policy.
If you are a typical American, policies affecting your health and medical care are made by the federal government, your state government, your employer (or school, or parent’s employer depending on your insurance plan), your insurance company, your state health department, your local health department, your physician, and most importantly, you as a patient.
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A key feature of President Obama’s health reform law, the Affordable Care Act or “Obamacare,” is that the massive bill vastly reduces the decision-making power of all but one of the aforementioned policymakers. Can you guess which one it expands?
The federal government, ding! ding!
While insurance companies and employers could previously determine what services and treatments were covered by each plan within a framework of state mandates, they will now have to include Essential Health Benefits (EHBs) in each plan.
EHBs are a federally determined list of 10 areas of coverage. While the specifics are to be ironed out by the states, this was a strategic decision to avoid doing a cost-benefit analysis of the regulation, not an acknowledgment of states’ abilities to best-determine which plans will work for their unique population or healthcare system.
The responsibility to choose a benchmark plan may fall to the states, but the Obama Administration will still have oversight powers and the ability to tell states to make changes at any time.
Religious entities that can currently choose healthcare coverage options for employees that align with their beliefs are no longer able to do so, as they will be mandated to cover contraceptives and sterilization procedures.
Physicians have historically been autonomous, trusted to make decisions along with a patient about his or her treatment plan. Obamacare erodes this autonomy, by implementing an Independent Payment Advisory Board (IPAB) which is charged with reducing Medicare spending. When you consider what IPAB cannot cut, it is likely that these savings will come from barring Medicare reimbursements for certain procedures, effectively limiting treatment options for patients.
Lastly, as Obamacare is not yet fully implemented, most consumers choose from among a variety of plan options, either on the individual market or through a third party payer, such as an employer.
This system is far from perfect and has few protections for those without employer-sponsored coverage; however, it allows for experimentation with a variety of health plans. Many popular plans, such as limited benefit (mini-med) plans or high deductible health plans – so widely used because they provide affordable coverage to young, healthy adults – won’t be tenable under Obamacare’s insurance regulation.
While “cookbook medicine” is a term thrown around to discourage one-size-fits all treatment guidelines, what has happened as a result of the Affordable Care Act is “cookbook health policy.” Every state, every county, every employer and every patient is different. Consolidating the power in the hands of the Obama Administration, via a bill passed without a single Republican vote, attempts to implement a one-size-fits-all health policy that is bound to be less effective and offer far fewer choices.
