Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions, and that some services are also cost-effective.
Under Section 2713 of the ACA, private health plans must provide coverage for a range of preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services.
So those with a clean genomic result might go for a cheap catastrophic plan, while those with a high risk of developing pricey illnesses will opt for more comprehensive insurance. And, unless the Supreme Court strikes it down, Obama Care essentially requires people to carry health insurance.
The result would be, in insurance terms, an “adverse-selection death spiral,” as the healthy opt out of expensive insurance, the sick opt into it, and premiums spin out of control. But the combination of federal laws mandating coverage regardless of pre-existing conditions and forbidding insurers to discriminate on the basis of genetic testing does further skew whatever “market” exists in healthcare.
In 2014, 26% of workers covered in employer sponsored plans were still in grandfathered plans, and it is expected that over time almost all plans will lose their grandfathered status.
The required preventive services come from recommendations made by four expert medical and scientific bodies – the U. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), the Health Resources and Services Administration’s (HRSA’s) Bright Futures Project, and HRSA and the Institute of Medicine (IOM) committee on women’s clinical preventive services.
New or updated recommendations issued by these expert panels are required to be covered without cost-sharing beginning in the plan year that begins on or after exactly one year from the latest issue date.
As we sequence more genomes, mine more data, and conduct more studies, we’ll find a lot more of these connections.I’ve argued for years that the combination of unsustainability high growth in health care costs and the enormous competitive disadvantage that puts on American business means that our current system of quasi-private, insurance-based medicine will collapse of its own weight.Like it or not–and I mostly don’t–Americans will wind up with some sort of government-centric model, likely one that provides basic coverage at a fixed price with some option for private supplemental coverage for those who can afford it.Eventually, genomic testing will be a powerful predictor of future illness.And it raises the potential that young people will get themselves tested and then purchase insurance based off the result.