Repeal of ObamaCare and Possible Effect on Your Nutrition Counseling Benefit

At the time this is written, it is still too early to tell whether or not the replacement for the Affordable Care Act will result in the loss of coverage for preventative healthcare services or not.  President Trump has stated that some parts of the healthcare law will remain.

What worries me, as a practice and business that highly uses insurance-based nutrition counseling benefits, is that the loss of the mandate will mean insurance companies could cut their coverage for the services I do unless you have a formal physician referral for a specific medical condition.

Currently, most people do not know (and your insurance company is very evasive in letting you know) that you MAY (about 80% of my clients) get 100% coverage before you even meet your (enormous) deductible for preventative nutrition counseling, unless you have a grandfathered plan from before the Affordable Care Act.

Specifically, I can use a preventative code as a dietitian for preventative services with many insurance plans that results in no copay or coinsurance (yea, too good to be true, right?).

As a licensed dietitian in private practice, I am not allowed to diagnose any specific medical condition and am restricted to using a preventative code or a BMI code (because it is a calculation) to support coverage for nutrition counseling.

This allows individuals to just see me to work on their health rather than having to go do extra work and get other diagnosis codes from their physician, which may be subject to copays, coinsurance, your (huge) deductible, and cost to see your physician for the diagnosis (which also costs money!).

If ObamaCare is repealed, then I sincerely hope that the clause that allows coverage for nutrition services (CPT codes 97802/3/4 medical nutrition therapy) with a preventative ICD-10 code remains for a few reasons:

1. Individuals who are overweight or obese without a formal diagnosis of a comorbidity (medical condition) face a financial barrier to getting on track with the professional who can literally reverse their condition without drugs or surgery.  Removing this barrier can be a huge boon to getting people in the door who need to work on themselves before they use a cop out excuse like “it is too expensive.”  Individuals WANTING to make a change to their diet and exercise habits needing legitimate information need all the support getting into my office they can get (a whole other blog post on the swamp of misinformation non-degreed fitness professionals give out about weight loss that you probably already self-pay for in personal training sessions).
2. America pays more for the disease than the prevention.  Small fires are easier to put out than blazing forest fires.  This is a metaphor to saying overweight is easier to treat than type 2 diabetes, surgeon fees for coronary artery bypass, chronic kidney disease dialysis procedures, and pharmaceuticals for band-aid-fixing diseases that can be cured with lifestyle change.  Supporting the healthcare professional, through health insurance, that facilitates lifestyle change is supporting a registered dietitian and exercise physiologist (me).
3. If my practice dwindles due to the repeal of the Affordable Care Act, I promise you that isn’t because everyone is healthy all of a sudden.  It is because there would not be coverage.  Even though the price of my services is inexpensive compared to what your surgeon or primary care physician costs, many people feel they are already paying for healthcare with their premiums, so they should not have to pay a dime more.  One of the major ways to have more coverage for services is if your premium is higher, to my knowledge.
4. Loss of coverage for nutrition services would be a step backward in fighting many of the health problems that are easily treated by diet, exercise, and lifestyle changes.
5. In appeal of Trump’s love for small business owners, as a small business owner, I have spent my blood, sweat, and tears slaving over my private practice for the past 3 years learning how to facilitate coverage for my services through health insurance for the benefit of helping clients and making a living myself.  By no means am I getting rich doing this.  I still work 7 days a week with a part time job seeing clients with my business and through an employer.  I have good success with the clients I do see (they let me know, or I see it myself).  I deserve to not have what I have built over 3 years burnt down just through a change in government administration.  I deserve to not have the rug pulled out from under my feet.  Not enough people are even using the benefit yet, nor is it advertised well enough through your health insurance company (probably because they think they lose money in the short term).

I agree the healthcare law is not perfect.  As a small business owner who is single, male and over age 26, I pay for my own health insurance through the Exchange without a husband or wife with a full time job with benefits a spouse can get on.  It is one of my biggest expenses next to paying for office space in Austin.

However, I also realize that as someone who is extremely fit, healthy, and barely uses his health insurance for anything except my flu shot and annual physical, I am paying for others who are not as fortunate as me to have the knowledge I do about nutrition and exercise and the desire to live the lifestyle.  And I’m fine with this.  I have no issues with it.  I can budget my money well if others need to use their health insurance more.

I know other young people are not aligned with this idea, and I do see the opinion that they feel they pay too much in premiums for something they don’t use and that as healthy people, they shouldn’t have to foot others’ healthcare bills who don’t care as much about their health as they do.

Clearly this is a complicated issue, and it is good that people can stay on their parents’ health insurance until age 26 and that 20 million more people actually have some coverage, but Americans also do not like paying for each other’s healthcare, and that is also a valid opinion.

I urge you to reach out to your representatives and senators with your concerns about the healthcare law reform.  If you are reading this post, you might care a little about preventative healthcare coverage and/or nutrition counseling coverage.  Please don’t be silent during this time when our voices need to be heard.

When it comes to nutrition counseling, Americans deserve legitimate information from a trained, degree-holding, licensed professional who is an expert on the subject and adept at working with individuals and groups.  Americans deserve the right to avert disease before it starts.  Americans deserve the right to prevent further healthcare costs down the road by taking action to a healthier lifestyle now, and they do not need additional financial barriers put in the way merely as a way to myopically cut costs and keep campaign promises.  Long term, it does not save.  Long term, we lose.

Yes, if you cut nutrition counseling, health insurance companies will save a little bit of money now.  But if you cut nutrition counseling long term, disease rates will go up and healthcare costs go up.  Clearly this is not a simple issue and needs to be considered carefully as a new healthcare law is implemented.

Edit 02/07/2017: A professional colleague alerted me to former President Obama’s recent article published in the New England Journal of Medicine on the possible repercussions and irresponsibility of repealing the ACA without a better replacement that is openly discussed first since posting this yesterday.

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