Essential Health Benefits: Pablum for the Masses

I am having entirely too much fun with the Affordable Care Act. The next item I would like to review is the list of Essential Health Benefits. I have entitled the posting “Pablum for the Masses.”

Pablum is an entendre on several levels: it means bland or insipid, which this Act most certainly is. It is a bland soft cereal for infants, and our government is certainly treating its citizens as infants by the passage of the act. Finally, it may mean simplistic writing, speech, or conceptualization, and the act is simplistic to the point of absurdity. I am also reminded of an “essential” quote by Benjamin Franklin who said, “Those who would give up essential liberty, to purchase a little temporary safety, deserve neither liberty nor safety.” The Affordable Care Act epitomizes the giving up of essential liberties (the right to choose one’s health care options) for temporary safety.  I believe that this act—as written—has the potential to bankrupt the health care system in our county. The result can only be one thing: the absence of safety and liberty.

Beginning in 2014, the Affordable Care Act mandates that health insurance plans offered in the individual and small group market place offer a comprehensive package of items and services. These items are the Essential Health Benefits. Additionally, States expanding their Medicaid programs must provide these benefits to individuals, who are newly eligible for Medicaid.

The Essential Health Benefits are: ambulatory patient services, emergency services, hospitalization, maternity and newborn care. They also include mental health and substance use disorder services, behavioral health treatment, counseling, psychotherapy, prescription drugs, rehabilitative services and devices (this includes physical and occupational therapy), laboratory services, preventive and wellness services along with chronic disease management, and pediatric services including oral and vision care.

The Affordable Care Act reminds me of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA quantified the provisions that were necessary for a qualified long-term care insurance contract to be considered “tax-qualified.” If the contract was “qualified” then it would afford certain tax favored benefits to the contract owner: tax free benefits and tax deductible premiums (within certain limitations).

The choice was left to the consumer whether or not to purchase the contract.  Individual liberties were not affected, citizens were rewarded for being responsible and the greater good was served. The bottom line is this: The Affordable Care Act and its Essential Health Benefits do not serve the greater good of you and me and those we serve and love.

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