Affordable Care Act, healthcare, Obamacare, Women — May 12, 2015 at 11:59 am

Obama administration stands up to health insurers on birth control coverage and more


Efforts will ensure compliance with the Affordable Care Act and help reduce out-of-pocket costs.

The passage of the Affordable Care Act (ACA) was a major step forward in comprehensive health reform. But everyone — including President Obama — knew from the start there was much more work to be done. Fortunately, the Obama administration continues looking out for the best interests of patients and healthcare consumers.

Following complaints and hard evidence that not all health insurers are complying with the ACA mandate to provide no-cost birth control to all insured women, the Obama administration issued new guidance from the U.S. Department of Health and Human Services (HHS) stating that insurers must cover a wide range of contraceptive methods at no cost to patients.

According to The Hill, the guidance clarifies exactly what insurers are obligated to cover under the ACA.

From HHS, quoted in The Hill:

Today’s guidance seeks to eliminate any ambiguity. Insurers must cover without cost-sharing at least one form of contraception in each of the methods (currently 18) that the FDA has identified for women in its current Birth Control Guide, including the ring, the patch and intrauterine devices.

According to a report issued last month by the nonpartisan Kaiser Family Foundation, some insurers were not providing all 18 forms of contraception at no charge. Five of 20 insurance plans it reviewed charged women for a vaginal ring, and one plan did not cover the contraceptive at all.

There’s also this, from UltraViolet, an organization that champions women’s rights:

According to a new report by our allies at the National Women’s Law Center (NWLC) analyzing over 100 insurance plans in 15 states, from California to Florida, many refuse to provide free or low-cost birth control coverage. Other plans refuse to cover maternity care, prescription drugs, and even well-woman visits. All of this violates the Affordable Care Act — it’s literally illegal and a blatant attempt to roll back reform.

The violations are widespread and reach into other areas of women’s health. Here’s a few examples from UltraViolet:

  • Some insurers are denying coverage for birth control methods like IUDs, then telling women they should just switch methods if they don’t want to pay out-of-pocket costs.
  • Eleven insurance plans in five states refuse to cover emergency contraception with a prescription.
  • Seven insurers in three states exclude women from coverage for genetic testing. This includes women who seek prenatal testing to determine the potential health of their child, as well as women seeking testing for the BRCA1 or BRCA2 gene mutation, which dramatically increase the risk of breast or ovarian cancer, a fact made well-known by actress Angelina Jolie.
  • Other insurers exclude women from coverage for sexually transmitted infections (denying coverage after age 24!), limit prenatal coverage to a single ultrasound (many women need two each month to monitor the health of their pregnancies), and limit preventive well-woman visits to one per year, and/or mandate that the visit only include a gynecological exam.

The Obama administration’s new guidelines are major step in the right direction toward making sure women receive the full spectrum of healthcare coverage they’re required to receive under the ACA.

UltraViolet’s activism has also resulted in some insurers changing their policies after women voiced their outrage. You can be heard, too, by signing UltraViolet’s petition.

In other news, the Obama administration is taking steps to resolve two of the most common consumer complaints about the ACA: inaccurate doctor directories and surprise medical bills for services not covered by insurance.

Anyone who has shopped for insurance through (myself included) can attest to how confusing it is to find out if your doctor accepts a particular insurance plan and exactly what’s covered. directs you to insurers for many of those details, which are often out of date. Plus, doctors can decide not to accept a particular type of insurance at any time. That’s not new or the result of the ACA — but it is a problem when consumers are trying to choose a plan that lets them see a specific doctor, or doctors are trying to find an in-network specialist to refer patients to.

Surprise medical bills are another huge concern. Because many consumers don’t fully understand how to shop for insurance — often looking only at monthly premiums but not other costs like co-pays — they can find themselves receiving high bills for services that make their out-of-pocket costs skyrocket. Customer service reps don’t always have the information they need to answer consumers’ questions, either.

Here’s the gist of the proposed resolution, according to The New York Times:

Federal health officials said … that they would require insurers to update and correct ‘provider directories’ at least once a month, with financial penalties for insurers that failed to do so. In addition, they hope to provide an ‘out-of-pocket cost calculator’ to estimate the total annual cost under a given health insurance plan. The calculator would take account of premiums, subsidies, co-payments, deductibles and other out-of-pocket costs, as well as a person’s age and medical needs.

On the day he signed the ACA into law, President Obama pledged to continue working to improve the law and expand health reform. Promise kept.

[Image credit: Women’s eNews, via Flickr.]