The Paradox of Generosity: Making Insurance Coverage Broader Can Lead to More Uninsured

Today’s Managing Health Care Costs Indicator is 1.5 million

The May 4 issue of the Journal of the American Medical Association  has a comprehensive literature review of the effectiveness of structured exercise in type 2 diabetics.  Those who begin an structured  program  to exercise at least 150 minutes a week have impressive improvements in their diabetes -- improvements akin to the results of adding an additional diabetes medicine to their drug therapy.

An accompanying editorial suggests that since structured exercise is so cost effective (between $14,000 and $69, 000 per quality adjusted life year) it should be covered by health insurance.

I'm a big fan of exercise - and I do think that breaking down barriers to exercise is important.  For many, the cost of joining a gym is beyond the budget.  However, I couldn't disagree more with this JAMA editorial.

We have a huge affordability problem.   Making health plans more “generous” through offering coverage for fitness club membership also makes them these insurance plans less affordable. This is not exactly an “unfunded mandate” in all instances under the Affordable Care Act, because the government will subsidize health insurance to the extent the cost exceeds 9.5% (or less) of income. Therefore, the government has a strong incentive to keep down the cost of health insurance.

Fortune Magazine  reports that chiropractors, patient advocacy groups, and a wide range of physician specialty groups are lining up to demand that HHS include more services in its list of essential health benefits.  It reports that a 10% increase in the cost of the essential benefits package would increase spending by $67 billion through 2019 and reduce the number of insured Americans by 1.5 million. 

We have to figure out how to avoid medicalizing a large range of important social issues, and we must have the discipline to NOT cover services that are not medically necessary.  Covering fitness club memberships through health insurance might feel good.  But it would paradoxically lead to a lower rate of those with insurance for truly ‘essential’ health care coverage.

Let’s not add more mandates that would make health insurance unaffordable for more Americans.