For some states, health reform might be a step backward
(Toby Melville - Reuters)
Parents of children with autism are anxious a new health reform regulation could roll back state-level protections for autism treatments, Phil Galewitz of Kaiser Health News reported this weekend. Right now, 26 states require insurers cover treatments for autism, things like behavior therapy and counseling. But that could soon change, as the federal government sets its own guidelines defining what insurers must cover.
By the end of this year, the Obama administration is expected to publish a regulation defining “essential health benefits,” the medical treatments all insurers must cover. That’s where autism treatments could fall through the cracks. “If states mandate a benefit, but it isn’t on the federal list, the states would be responsible for the cost of the coverage,” Galewitz writes. “As a result, autism benefits and dozens of other state-required benefits, covering services such as infertility, acupuncture, and chiropractic care, could be at risk.”
It’s not just autism benefits caught in the crosshairs here. States that have been aggressive on health reform and insurance regulation are starting to find that, in some cases, federal reform could prove an obstacle. Connecticut, for example, recently backed off of a public option plan that it had been pursuing for years. As Gov. Dan Malloy, a Democrat, told me in an interview earlier this year (subscription required), Connecticut could only handle one big health policy push at a time. “My preference is we digest the federal side first and understand its implications for health care in Connecticut,” Malloy said. “As committed as I am to the principles of SustiNet [the public option plan], trying to build SustiNet at the same time we’re working on our exchange ... that seems to break the back of our ability to implement either system.”
If the single-payer plan Vermont passed this year is to succeed, its will require many waivers from the Affordable Care Act. And Healthy San Francisco, the California city’s universal coverage program, estimates that it’ll lose about 60 percent of the people it currently serves (and serves well) to health reform programs.
These states, as well as patient advocacy groups, have generally supported the health reform law, and continue to do so today. At the same time, they’re finding it a bit of a double-edged sword, a step forward and backward at the same time.
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