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Who Should Help Pay for Yoga?

Let's hope that our health insurers and legislative policymakers realize that coverage of yoga is a natural next step.
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At a yoga class last week, a fellow yoga student talked about how the cost of yoga classes adds up. It's true. The expense of yoga classes can range in most cities between $15 to $25 per hour-long class. Even with packages that run anywhere from $90 to $180 per month, it is a real investment (though, in my opinion, a very worthwhile one). On the flip side, running a cost-effective yoga studio often necessitates such prices. Yoga studio owners must cover costs of marketing to fill classes, high rental rates, equipment and other overhead costs, and pay yoga teachers fairly.

But there is a third payer option that could help more people access and afford yoga: health insurance companies. Some health insurers already cover many forms of complementary health therapies, such as acupuncture and massage. Plus, health insurers often reimburse gym memberships or partner with fitness programs to provide a discount, so it's worth asking your individual insurance company. But most health insurers do not cover yoga, so we end up paying out-of-pocket.

The Affordable Care Act (ACA) aims to cover preventative medicine and wellness-based treatment, but does not specify coverage of complementary health therapies like yoga. As a result, coverage of complementary health treatment currently varies based on state law and individual insurers and plans. A handful of states require coverage of complementary health care. Since 1996, Washington state law has required coverage of licensed complementary and alternative medicine providers. In 2014, acupuncture became an "essential health benefit" and covered under the Affordable Care Act in California.

Here are four reasons we should expect to see yoga and other mind-body programs covered by health insurers and included in the Affordable Care Act as well.

1. Yoga has a strong scientific evidence that yoga promotes physical and mental health.

Yoga can improve heart health, cancer recovery, and chronic pain. Yoga has been shown to improve mental health by reducing stress, depression, and anxiety.

Research of yoga have more than tripled in the past decade. The majority of yoga studies are randomized control trials--the gold standard of scientific evidence. Neuroimaging studies have shown that yoga and meditation change the brain and genetic studies reveal that yoga could even impact gene expression at the molecular DNA level and protect our the longevity of our DNA.

"The use of mind body integrative medicine approaches has accumulated a scientific basis that is increasingly hard to ignore, especially with the support it has received from neuroimaging and epigenetic data," notes Dr. Gregory L. Fricchione, Director of the Benson-Henry Institute for Mind Body Medicine and Associate Chief of Psychiatry at Massachusetts General Hospital.

2. Yoga programs have been shown to reduce hospital visits by 43%, which could translate into thousands of dollars in health care savings.

Stress is one of the top three health care costs in the U.S., behind only heart disease and cancer. Stress-related problems account for up to 80-90% of visits to the doctor, but only 3% of doctors talk about how to reduce stress with their patients.

A recent study conducted by Dr. James E. Stahl and his team at Harvard-affiliated Massachusetts General Hospital found that people who participated in an 8-week yoga and meditation program used 43% fewer medical services than the previous year, saving on average $2,360 per person in emergency room visits alone. This means that such yoga and meditation programs could translate into health care savings of $640 to $25,500 per patient each year.

Health care consultants have also recommended that health insurers cover wellness and prevention-based therapies like yoga in a recent article in the Harvard Business Review. Aetna, under the leadership of chairman and CEO Mark T. Bertolini, offers free yoga and meditation programs for Aetna employees. A study of Aetna employees who participated in the company's mindfulness program found 28% reduction in stress, 20% better sleep, and 19% less pain. This translated into increased worker productivity worth an estimated $3000 per employee per year.

3. The number of people interested in yoga is growing rapidly.

Yoga is the most popular form of mind-body practice in America today. One in 10 Americans are doing yoga, and nearly half of people who haven't tried yoga yet are interested in learning.

This means that if yoga was made more affordable and accessible through health insurers, it's likely many people will actually use this insurance benefit. This would be consistent with past studies that have found a high number of people using complementary health benefits when offered.

4. Yoga provides tools that people can continue at home to create lasting benefits.

What is a better investment than a low-cost yoga and meditation program that teaches people skills that they can take home to continue these health benefits?

Dr. Stahl, who is now section chief at general internal medicine at Dartmouth-Hitchcock Medical Center, teaches his patients mindfulness skills in his internal medicine practice and encourages people to practice daily at home. "The biggest thing that people need to do--whether it's meditation, yoga, or something else--is that you only need to spend 10 to 15 minutes a day, but the real key is consistency," Dr. Stahl recommends.

There are free and affordable resources online to learn yoga and meditation, but yoga classes in-person allow teachers to help correct your alignment and provide the energy and support of a group class. For affordable classes, look for local community yoga classes that are often complimentary or donation-based.

With growing evidence the health benefits as well cost-effectiveness of yoga and mindfulness programs, it will become increasingly difficult for health insurers to overlook yoga. If we can work to remove the cost barrier of yoga for our community, we get can get healthier, prevent illness, improve existing medical problems, and potentially reduce health care costs.

Let's hope that our health insurers and legislative policymakers realize that coverage of yoga is a natural next step.

Marlynn Wei, MD is a board-certified psychiatrist, yoga teacher, and author of The Harvard Medical School Guide to Yoga, with co-author James E. Groves, MD.

Connect with Dr. Wei on Twitter @newyorkpsych | Facebook