Acupuncture as ‘essential’ health care? California weighs the question.

September 1, 2012

States are in the middle of answering one of the health law's most important unknowns: What health benefits should every insurance plan be required cover?

In California, the answer is coming together quickly  -- and, if all goes as planned, acupuncture will be on the list.

A bit of background: The health care law will, beginning in 2014, require all insurance plans to cover a specific set of benefits. The health law includes 10 broad categories that must be included -- things like "ambulatory care" and "prevention" -- but left the task of fleshing out a specific list to Health and Human Services.

Health and Human Services then turned the job over to the states: In a December rule, the department announced that states had four options for deciding what their health plans would need to cover. States could tell insurance companies to cover whatever one of their larger, small group insurance plans in the state covers. Or, they could benchmark their plan to cover the benefits that state employees get.

That brings us to California. There is now legislation on Gov. Jerry Brown's (D) desk that would benchmark the state's essential benefits to a small business plan offered by Kaiser Permanente. Emily Bazar tracked down a copy of what that plan covers. It includes the things you'd expect, like preventive care visits and hospital stays.

It also has a few benefits you might not have seen coming. Acupuncture, "typically provided only for the treatment of nausea or as part of a comprehensive pain management program for the treatment of chronic pain," is included with a $30 copay per visit.

“It’s historic,” Assemblyman Bill Monning told Bazar. He argues that the bills will affect “the millions of Californians who have had limited coverage or no coverage who now will have access to coverage, and it will be comprehensive in nature."

It will not, however, cover everything. There's a laundry list of benefits that did not make the cut. Infertility treatment, massage therapy and hair growth treatment are excluded from this benchmark plan.

For California -- like any state -- it's a bit of a balancing act. The goal is to provide comprehensive coverage. At the same time, legislators have to be mindful of the budget: A package with too many benefits could end up unaffordable and inaccessible to the people Obamacare is supposed to cover.

That's why you could see skirmishes over some benefits like acupuncture and massage therapy, as states decide what health care counts as essential and what doesn't.

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Brad Plumer | September 1, 2012