Why Marijuana Dispensaries Won't Be Part of Your Obamacare Health Plan

CNN's Sanjay Gupta has seen more than his fair share of political rough-and-tumble. As the resident doctor at Ted Turner's media empire, he's sumo-wrestled Michael Moore over universal healthcare, and bravely ventured into the Gardasil controversy. But few expected our Asiatic Asclepius to have such an abrupt turnaround on medical marijuana.

In an article last week, Gupta cited new scientific research in apologizing for previously being against patients smoking pot. The renewed debate resulted in the CNN-produced documentary Weed, starring the good doctor himself. As Dr. Gupta goes, so goes the nation; polling trends show that the leafy-green substance is really growing on the mainstream public. Even as states and their elected officials support increased access, don't expect weed to come to a health insurance plan near you.

For the sickest among us, cost and access are major barriers to puffing and passing. Just ask Steph Sherer, the executive director of Americans for Safe Access. Her neck disorder puts her in constant pain, yet her $300 weekly marijuana spray regiment threatens to break the bank. The picture is even bleaker for HIV-stricken Colorado resident Damien LaGoy, who is unable to afford both the state application fee and the pot itself. In a teary appeal to the State Board of Health, LaGoy explained, "I don't have the $90. I have a $1.15 in my bank." Typically, medical goods with large incremental costs are sold through insurance policies. What sets marijuana apart from any other prescription medication in a state like Colorado? Susan Pisano, a spokeswoman for a trade group representing insurance companies, explains that there are "legal issues" stemming from state-federal conflict. Why, after all, would a corporation like Humana or Aetna risk the wrath of the law just to allow Damien or Steph a toke? 

But even if the Obama administration decided to remove marijuana as a Schedule-I substance tomorrow, serious issues would remain. Insurance giants considering medical marijuana would be seriously dissuaded by new Affordable Care Act provisions. Unbeknownst to most of the public, the ACA requires companies to spend a certain percentage of their funds on consumers relative to what they keep in profit and administrative expenses. This is designed to reduce the fat in the insurance industry, and make corporations lean, cost-cutting machines. 

Considering that the main targets of the ACA are twenty-somethings, this can pose a serious dilemma. In a free market, insurance companies could market themselves to younger audiences by offering, well, very cheap medical dope. Given the low cost of marijuana relative to other medication, companies might even offer it to old folks as well. Under Obamacare, however, a surge of new patients and the low-added cost of embracing marijuana might be a deadly combination. This could easily put the company's medical-loss ratio too low; the company would see a large profit spike without an accompanying spending spike.

An opposite, but no less frightening, scenario could also occur. Insurance companies are now legally required to offer an "essential benefits" package, with Health Secretary Sebelius deciding what must be in plans offered on exchanges. For a plan to pass muster, it must include a drug from each of the "classes" defined in U.S. Pharmacopeia guidelines. Given the cost that will come with insurance companies adapting essential benefits, anything not automatically included might remain permanently off the list. If Aetna is required to offer an expensive plethora of drugs for each plan, why would it doll out even more for an experimental cannaboid drug? The incentives would be completely dependent on how marijuana medications were classified by the U.S. Pharmacopeia, but there is reason to be worried. Mandating lavish benefits that patients might not even need is a one-size-fits-all solution, and invites corporations to skimp out on cutting-edge cannaboids like Marinol. 

Pundits and professionals lightening up on pot will hopefully lead to patients such as Damien LaGoy lighting up. Regardless of our feelings about recreational usage, its imperative that we allow folks like him something to ease the pain. There's no shortage of barriers, though, with the federal government clumsily intervening in our medical decisions. In speaking out against these policies and acknowledging past mistakes, we absolutely need more Dr. Guptas. By ending the prohibition of our time and moving health care reform in a free-market direction, we can finally give our sickest brothers and sisters a lasting refuge from pain.