Prevention Matters

U.S. health plans "appear to be getting the message" that they should offer free tests to encourage prevention, but they aren't rushing to embrace a proposed government mandate of first-dollar coverage of clinical preventive services.

Phil Galewitz of Kaiser Health News talked to insurance officials to get their take on first-dollar coverage.

"Aetna, one of the nation’s largest insurers, this year began introducing health plans for small employers that charge patients no co-pays for preventive care such as routine physicals, vision and gynecological exams, and well-child visits," Galewitz wrote.

"The company says it is pricing that new plan the same or nearly the same as what the existing plans would have cost, although it has increased co-pays on certain other benefits.

"Aetna spokesman Mohit Ghose on Friday said the company strongly supports efforts to promote prevention in health reform. He declined to say whether the company would support a government mandate eliminating copayments for preventive services.

"America’s Health Insurance Plans, the industry’s top lobbying group, opposes the mandate, said spokesman Robert Zirkelbach. He cited the need to give insurers flexibility in designing benefit packages.

"Wellpoint, the largest Blue Cross and Blue Shield company, said it sees the benefit for waiving cost sharing but doesn’t want the government mandate.

“'Many of WellPoint’s affiliated health plans’ benefits already offer preventive services with no co-pay or deductible as we feel these are important services,' said spokeswoman Cheryl Leamon. 'We also believe it is important for our members and others to have the choice in the type of health plan and benefits that fit their needs.'”

President Obama recently cited "no cost sharing for preventive services" as one of eight protections he wanted a health reform bill to provide.

The bills currently working their way through Senate and House committees all mandate Medicaid coverage of clinical preventive services. The House Energy and Commerce Committee last week approved an amendment by Rep. Lois Capps, D-Calif., that would prohibit cost-sharing for clinical preventive services provided to Medicaid patients.

Dr. Steven H. Woolf attracted national attention in February with a commentary he wrote in JAMA about the value of prevention in the health reform debate. That commentary synthesized a scholarly paper Woolf and others prepared for Partnership for Prevention rebutting critics who have downplayed prevention's place in the debate on the grouds that it did not save money.

Woolf, a professor of family medicine at Virginia Commonwealth University, has now been invited to address the America's Health Insurance Plans (AHIP) Institute 2009 about his work. He will speak at a session on "The Economics of Disease Prevention" that is scheduled for for 11:40 am Thursday, June 4, at the San Diego Convention Center.

"Your recent article in JAMA and your work with the Partnership for Prevention are very important to health care reform and for stakeholders wrestling to balance cost and quality in a struggling economy," Stephanie Lentz Dougherty, AHIP's Senior Director of Professional Education, said in her invitation to Woolf.

AHIP's Institute is the nation's leading conference for the health insurance industry attended by more than 3,000 health care leaders. The educational content at this year's conference has an emphasis on health care reform.