After health reform, who will decide what medical services insurance companies must cover? The House and Senate HELP committee bills empower an independent council of medical experts to make coverage recommendations to the Health and Human Services secretary. This is the group that would make controversial decisions about whether abortion, infertility treatments, or certain experimental procedures should be covered in basic health plans. The White House plan released yesterday stays silent on the question of who decides coverage specifics -- and that is likely because there is now an alternative in town. Sen. Max Baucus' Finance Committee plan articulates broad areas of coverage that must be included, such as preventive care, primary care, hospital stays, and maternity care. But Baucus would allow insurance companies themselves to define what services each of those areas include, without government interference. Insiders say Baucus left the independent council out of his plan because moderate Republicans don't like the idea of restraining the private market in this way. What does Baucus' compromise mean for reproductive health coverage, which remains a source of debate as Congress discusses reform? Advocates are cautiously optimistic. "Services like contraception, STI testing and treatment, and Pap tests can and certainly would fit into many of the other categories," such as preventive care, says Adam Sonfield, senior public policy associate at the Guttmacher Institute. "Reproductive health services, including contraception, would likely be covered in almost every plan, because that’s the way coverage is today. ... It makes financial sense for insurance companies. Contraception is very clearly cost-effective." Under the Baucus plan, abortion coverage would likely remain unchanged; there is no public option, and private insurance companies would determine individually whether to cover the procedure, as they do now. Eighty-seven percent of current employer-based insurance plans do provide some abortion coverage. --Dana Goldstein
