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Excluded Benefits Lists Spark Debate

 |  By Christopher Cheney  
   March 05, 2014

President Obama's hallmark domestic policy initiative has been blunting the worst shortcomings of the US healthcare system. But it is unrealistic to expect the PPACA alone to totally transform the practice and financing of medicine.

"Every revolution evaporates and leaves behind only the slime of a new bureaucracy." Franz Kafka

After receiving a recent study on the Top 10 medical services excluded from health insurance policies on the new public exchanges, my first reaction was "here we go again" – here is yet another black eye for the PPACA rollout., which is based in Sunnyvale, CA, found that eight of the top 10 medical services excluded from health insurance policies before the PPACA are also excluded from insurance policies on the new public exchanges. "There hasn't been a dramatic change from the pre-exchange market to the post-exchange market," Kev Coleman,'s head of research and data, told me last week.

But on close examination, Coleman says, it becomes apparent why the pre-exchange and post-exchange Top 10 lists are nearly identical, for a host of financial, historical and moral reasons. "The health system expresses itself in that Top 10 list," he says.

The No. 1 medical service excluded from insurance policies before and after creation of the new exchanges is long-term care, which is associated with burdensome costs. "Long-term care is extremely expensive," Coleman said. "If you're inside any institutional facility, it costs tens of thousands of dollars."


Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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