I posed this question to Al Lewis and Vik Khanna in the comments of their recent post entitled: The High Cost of Free Checkups, where they argue against the Affordable Care Act (ACA) provision that requires “free checkups for everyone.” They cite a recent New York Times Op-ed authored by ACA co-architect, Dr. Ezekiel Emanuel, that essentially debunks the link between annual checkups and overall health outcomes. For Lewis and Khanna the solution is simple, we need to “remove the ACA provision that makes annual checkups automatically immune from deductibles and copays.” But for me there’s an enormous problem with their argument: The ACA doesn’t actually have any such provision.
After raising the issue in the comments section of the post, Mr. Lewis responded informing me that: “It’s definitely there” and “You’ll have to find it on your own, though — I unfortunately have to get back to my day job.” What Mr. Lewis doesn’t consider with his quick dismissal, is that I have already looked. I’ve combed through the law and other policy guidance, rules and regs; searching for any mention of this required annual wellness exam, physical, visit, or any other linguistic derivative. It doesn’t exist.
It turns out that while the law does require that an annual wellness visit be covered (sec. 4103. “Medicare coverage of annual wellness visit providing a personalized prevention plan”), this requirement is specific to Medicare beneficiaries and does not apply to individual or group plans. Beyond this particular section you won’t find any mention of a requirement within the ACA.
So what gives? Lewis and Khanna aren’t the only ones who’ve mentioned this “free” Obamacare benefit. Even when researching this piece I had to engage in a lengthy discussion with a friend who is a healthcare policy advisor, unexpectedly defending my position. This claim has to be coming from somewhere, surely people smarter than me have gotten it right?
I suspect the confusion stems from the fact that the ACA makes preventive services free for virtually everyone. But that’s not the same thing as saying everyone is entitled to a free annual checkup. When you read sec. 2713. “Coverage of preventive health services” of the ACA, it basically says that in the Individual and Group markets, at a minimum, insurers must provide coverage (meaning they must pay 100% of the cost) for certain preventive benefits and services. It goes on to state that those services are defined as “evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;”
In other words, outside of a few mandated preventive services (such as visits for women and children only), the law leaves it up to this independent task force to determine what preventive services should be covered for free. Several of these services aren’t available every year and in the aggregate, they don’t necessarily comprise all the services typically included in the annual wellness exam. As Dr. Emanuel points out in his Op-ed, the lack of evidence that annual checkups lead to healthier outcomes is the main reason that same task force “does NOT have a recommendation on routine annual health checkups.”
Propelled by a derisive political debate primarily concerned with the promotion or denigration of this new healthcare law, somewhere along the way we’ve gotten it twisted. And while I wouldn’t normally care, navigating the truths of the industry is complex enough. It get’s that much more difficult when those truths are littered with negligent misinformation.
So, I’d like to take this opportunity to once again ask Mr. Lewis or Mr. Khanna: “Where in the ACA does it require insurance companies to provide a free annual checkup for everyone?” As a longtime reader of this blog I’ve always appreciated the provocative content, discussions, and thought leadership inspired herein; but I’ve never actually written anything. In this case, I just felt strongly about correcting the record, because understanding the ACA doesn’t have to be your day job to care about the veracity of what you write.
Christian Gleason is a healthcare marketplace analyst with GetInsured.com