Preventive Care Mandates Could Lead to Out-of-Control Costs and Unaffordable Health Insurance Premiums

SAN JOSE, CA–(Marketwire – August 11, 2010) –  Beginning on September 23^rd, the Patient Protection and Affordable Care Act will allow consumers who purchase new or revised insurance plans or policies to receive an array of preventive care services with no out-of-pocket cost. The Foundation for Health Coverage Education (FHCE), www.CoverageForAll.org, while applauding any efforts to keep overall health care costs down, cautions that this provision could instead lead to out-of-control medical costs which will escalate insurance premiums.

“While mammograms and colonoscopies clearly provide preventive services that are cost-effective and can save lives, one has to question the government’s waiving the total cost to the consumer for smoking cessation, and weight loss and alcohol treatment, which are included in these mandated services. A line must be drawn by the government as to where its funding ends and where personal responsibility begins,” said Phil Lebherz, FHCE Founder and Executive Director. 

“Behavior modification programs represent a billion dollar industry with high recidivism rates. As a result, because they will be available at no cost, enrollments in programs to combat the effects of lifestyle diseases from smoking, obesity and alcoholism will ratchet up costs with little expectation that the consumer be responsible for making healthy lifestyle choices,” said Lebherz.

The new law will require that individual policies and employer-based health plans offer certain mandated preventive health care services with no out-of-pocket costs to Americans
when they enroll in either new individual health policies or new group health plans. Going forward, the consumers with the new policies or plans will not be charged a co-payment, coinsurance or deductible for certain preventive services performed by a network provider, doctor or testing service, covered under their policy. Consumers who keep their grandfathered plans and do not change their existing individual coverage or whose employer-based group plans are not changed considerably, won’t be eligible for mandated services that have no cost out-of-pocket expenses. 

“The government cannot legislate personal responsibility,” Lebherz said. “If it’s free, it will increase costs and accomplish little because people in counseling for obesity, alcohol, and or smoking sensation tend to backslide and readmit to programs. In fact, new policies will cost more than the grandfathered policies.”

Mandates can provide a greater range of care, but they also mean increased premiums as insurers must cover out-of-pocket costs that were originally paid by consumers. The accumulation of mandates plays an important role in raising costs. According to the Council for Affordable Health Insurance (CAHI), there are over 2,000 mandated benefits. CAHI’s studies show that mandated benefits could increase the cost of basic coverage from approximately 20% to as much as 50%, depending on the number and design of the benefits, as well as the initial cost of the premium.

“It’s important for everyone to have adequate health coverage, but we have to draw the line somewhere,” said Lebherz. “Making healthy personal lifestyle choices are within the reach of all of us,” said Lebherz.

Launched in 2004, CoverageForAll.org is America’s first public health insurance search engine, helping over two million Americans discover their public and low-cost private health insurance options. Every month 70,000 people visit the website or call the free 24/7 multilingual U.S. Uninsured Help Line (800-234-1317) to take the simple 5-question Health Coverage Eligibility Quiz and speak with a live health insurance specialist who can walk them through the process, connect them with the programs and applications and provide them with a sign-up checklist needed to successfully apply. 

For information regarding health insurance and health care reform changes, please visit www.CoverageForAll.org or call the toll-free 24/7 U.S. Uninsured Help Line 800-234-1317. The Foundation for Health Coverage Education is a 501 (c) 3 national non-profit organization with a mission to provide simplified public and private health insurance eligibility information in order for more people to access coverage.

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