Infertility and the Affordable Care Act: Part 1

November 6, 2013Carole 4 Comments »

Davina Fankhouser, co-founder of Fertility Within Reach, published a very informative blog post today that explains what the Affordable Care Act (also called Obamacare) mandates. Read the whole post here. It explains the basics that apply to all health care. In her second post, she will specifically talk about the expected impact on infertility.

Some highlights :

The ACA is a federal law that sets standards for insurance coverage, establishing minimum standards that all insurance coverage must provide.

The Secretary of  Health and Human Services identified 10 Essential Health Benefits (EHBs) including

  • ambulatory patient services;
  • emergency services;
  • hospitalization;
  • maternity and newborn care;
  • mental health and substance use disorder services,including behavioral health treatment;
  • prescription drugs;
  • rehabilitative and habilitative services and devices;
  • laboratory services;
  • preventive and wellness services and chronic disease management; and
  • pediatric services, including oral and vision care

Where do the states come into play? Each state can decide which plans meet these basic requirements and which plan (either a current state plan or a federal plan) is the benchmark plan for their state. They can have two kinds of benchmark plans, one offered as their commercial benchmark plans and one offered through their exchanges.

The media has given a lot of air time to people who are upset that they are not able to keep their dirt-cheap insurance plans, because the insurance companies were no longer permitted to offer these crappy plans which did not meet the new minimum standards–and  in some cases–gave patients a false sense of security–when in reality, they were still exposed to excessive financial risk. Medical bills are the primary cause of bankruptcy in the US. The ACA already benefits patients.  Now insurers, because of the law, are no longer able to take away your insurance if you have a pre-existing health condition and can’t dump you if you develop a serious health condition. As a bonus- you have the option of keeping your children on the family plan until they are 26 years old.

The ACA addresses real disparities in our health care system. Millions of people have inadequate or no health insurance and are getting only last ditch extremely emergency room care in lieu of primary care. That is not acceptable -or sustainable–for a modern society.  Social Security and Medicare also had massive resistance when first introduced,  were grudgingly passed with a majority of Democratic votes and a minority of Republican votes,  but now are considered essential social programs. I realize that the Obamacare roll-out has been –pick any negative adjective you like– you’ve heard plenty on the news. But the website is fixable–how can it not be?— it’s  a matter of time and resources. Social Security and Medicare both underwent modification as they moved forward as problems were found and addressed. Why should this be different? Did Americans become less capable? I don’t think so.

There is a lot more info about the ACA in Davina’s post and I would encourage you to read all of it; including  information on subsidies to make the plans affordable, links to even more information. Stay tuned for her next post, on what impact the ACA may have on infertility coverage specifically.



© 2013, Carole. All rights reserved.

4 Responses to this entry

  • Jen Says:

    I’m really disappointed to see this on your site. 🙁

  • Andrew Says:

    As am I Jen. I will not be coming back to this site.

  • Lynne Says:

    Wow, I guess it’s better that people not come back to the site if they prefer to allow their political bias to get in the way of the factual, logical information that Carole has presented.

    As a fellow scientist, I thank you for this fair-minded post, as well as all of the others!

  • Nel Says:

    I don’t have a problem with this post, but to say it is fair-minded and only presents factual, logical information is ridiculous. It clearly advocates a particular viewpoint and since it’s Carole’s blog – advocate away! I accept that I do not agree with Carole on her thoughts of insurance or ACA, just as I accept that she is undoubtedly an expert in fertility labs with much information and insight to offer. It’s okay – we don’t have to agree, but we all should be respectful and not dismiss another’s viewpoint.

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