CNN’s Chief Medical Correspondent On Need For Essential Health Benefits: “People Don’t Know What They Need Until They Need It”Dr. Sanjay Gupta
(Media Matters) – CHRIS CUOMO (HOST): But there is a basic proposition at play here that should be addressed. [Chris] Cillizza raised it, and we’re lucky to have Gupta to deal with it, which is this: I don’t need maternity care. The idea of a la carte services sounds so good to people when it comes to insurance. I don’t need all these different things. I’m going to check them off, and I’m going to pay for my plan. I don’t want to pay for what she needs. What is the reality of how insurance works, Sanjay?
SANJAY GUPTA: I think that may be one of the most critical issues here for the consumer or the potential patients of which we are all potential patients, right? But these essential health benefits, this idea you buy an insurance plan that needs to have some basics, right? Because a lot of people don’t know what they need until they need it. So, that’s part of the problem. That’s the nature of insurance. So, if you don’t have certain things in the health benefits and then all of a sudden you need them, your insurance plan hasn’t done you any good. For example, these skinny plans that we talk about sometimes, they may not have inpatient hospitalization covered. OK, so you’re 25 years old, you’re immortal in your own mind. You think, I just need a skinny plan. Then you get into a car accident or you’re diagnosed with some sort of disease, that’s the most common reason you are going to be going to the hospital, and all of a sudden your plan doesn’t cover it. So, that’s part of the issue with these essential health benefits. And I think that that’s a really important point.
I’ll just make a quick thing about maternity health benefits because people scratch their heads and say, “Men — why would you need maternity health benefits?” The problem is that, otherwise only women are going to need those, and that’s called gender rating. That’s essentially charging women more because they are women. When you make everyone buy maternity ratings, this is how you help defray the cost, so everyone’s sort of — so you’re not basically penalizing somebody in this case for possibly getting pregnant. So, that’s why you have that. But the whole idea, again, is to have everyone have a minimum level of care at least.