I posted the other day about the gray area between the definitions of medical care and administrative expenses, and their importance to loss ratios. But that’s not the only area that’s going to need a very specific definition under PPACA.
One of the biggest reasons for opposition had to do with coverage of controversial procedures. Abortion, unsurprisingly, is the procedure with the most attention but those following that debate would be wise to consider that it’s not the only one.
Still, it’s a good example of the issue at hand. Abortion is always an elective procedure, but what if it’s done following a rape? Is that an exception that crosses the line into medical care?
Pro-abortion advocates would say yes, and a significant number of anti-abortion advocates would agree. But there’s also a significant population that would say it is not.
“We don’t consider elective abortion to be health care, so we don’t think it’s a bad thing for fewer private insurance companies to cover it,” said Mary Harned, attorney for Americans United for Life, a national organization that wrote a model law for the states.1
The solution used for PPACA was to hold to the long-standing Hyde Amendment. Beyond that, the decision whether abortion is medical care was left up to the states and to private insurers who don’t use (or don’t completely use) federal funding.
But is that really the best idea? One of the biggest issues that led to the need for health care reform was the inconsistent coverage offered on the private insurance market, despite federal regulation in the forms of COBRA, ERISA and HIPAA.
The reason they weren’t enough to solve the problem was because there was too much leeway in plan design and procedure exclusions. PPACA puts restrictions on both of those coverage aspects but they aren’t absolutes. Thus, there’s leeway that will make an impact on the covered insureds.
“It’s really going to be a patchwork of state laws by the time these exchanges are set up,” said Jessica Arons, director of women’s health at the Center for American Progress, a liberal public policy institute.2
Despite the fact that I oppose abortion, I have to agree with Ms. Arons. The Obama administration’s decision was essentially not to make a decision when it came to abortion coverage. This has opened up a furious debate and, since PPACA primarily leaves the decisions up to the states, will mean that the state of issue for a health insurance plan does matter.
Wasn’t that one of the things that PPACA was trying to prevent?
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