Will insurers be forced to pay for pseudomedicine? Tell HHS "no!"

Will insurers be forced to pay for pseudomedicine?  Tell HHS "no!"

Section 2607 of the Affordable Care Act (ACA) prohibits "discrimination" against state-licensed health care providers:

(a) PROVIDERS.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

Section 2607 was inserted into the ACA, without any committee discussion, under the leadership of Sen. Tom Harkin. Harkin is the powerful (but now retiring) Senator who is largely responsible for the creation, and continued funding, of NCCAM, which has wasted a couple of billion dollars of taxpayer money researching fantasy treatments like homeopathy and acupuncture.  (To be fair, Sen. Harkin is also a big proponent of doing real research too, and has been a champion of the NIH.)

Naturally, this provision is of concern to supporters and practitioners of science-based medicine, who see the possibility of forced insurance coverage for the type of psuedomedicine provided by naturopaths, chiropractors, and acupuncturists. If you are reading this, I hope I can assume this means you are concerned. Read on while I give you some background, then I'll tell you what you can do about it.  

State legislative mandates requiring coverage already exist, but so far the insurance companies have held the line by excluding what most of them call "experimental" treatments, by which they mean treatments without adequate evidence of safety and effectiveness. In other words, a lot of what we could call "alternative" medicine. 

No one is quite sure what "discrimination" means as it is used in Section 2607.  I doubt it will be interpreted to mean that anything a naturopath does is ipso facto covered.  After all, insurers aren't required to cover every diagnosis and treatment of every other provider.  Here's where I see the danger though.  Naturopaths claim they are primary care providers, able to practice "conventional" medicine as well as an M.D. or D.O.  This is absurd, of course -- for starters, they don't even have residencies.  And too much of their education is spent on subjects like homeopathy, dietary supplements and acupuncture.  

Unfortunately, naturopaths have the same scope of practice as M.D.s and D.O.s in a number of states.  So, while insurers might not be forced to cover all of their treatments, they would be forced to cover such things as screening tests, annual exams, well-baby care, and other services M.D.s and D.O.s get reimbursed for.

Even chiropractors are arguing that they can provide primary care and should be covered as PCPs under the ACA.  Does this mean insurers will have to pay them if they want to act as someone's PCP?  

The Department of Health and Human Services (HHS) put out a "FAQs" giving its interpretation of Section 2607:

 to the extent an item or service is a covered benefit under the plan or coverage, and consistent with reasonable medical management techniques specified under the plan with respect to the frequency, method, treatment or setting for an item or service, a plan or issuer shall not discriminate based on a provider's license or certification, to the extent the provider is acting within the scope of the provider's license or certification under applicable state law. The FAQ also states that section 2706(a) of the PHS Act does not require plans or issuers to accept all types of providers into a network and also does not govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations.

Sounds reasonable to me, but Sen. Harkin and his committee didn't like this at all.  So now HHS and other government agencies are seeking public comment:

Pursuant to [the Senate committee's] report, the Departments are requesting comments on all aspects of the interpretation of section 2706(a) of the PHS Act. This includes but is not limited to comments on access, costs, other federal and state laws, and feasibility.

That is where you come in.  Comments close June 10,2014, so times a wastin'.  Go to the Comments website and let the government know what you think.  It's rare that the average citizen gets to sound off against pseudomedicine, which is carefully curated for public consumption by CAM sycophants. Don't miss your opportunity.

 

 

 

 

 

 

 

 

 

Points of Interest 5/18/2014
Lipstick on a Pig?