Coverage requirement for contraceptives rolls out
By Adam Sonfield
Senior Public Policy Associate
Guttmacher Institute
Washington, DC
Throughout the first half of 2012, debate raged in Washington and in the media over a new requirement under the Affordable Care Act that most private health plans provide coverage of contraceptive methods and counseling without additional out-of-pocket costs, such as copayments and deductibles. Despite that debate, the key date of Aug. 1 came and went with relatively little fanfare. On that date, the new requirement — along with coverage requirements for many other preventive care services for women, from HIV screening to breast pumps — began to take effect.1
Because the requirement affects plans when they start a new plan year, it will phase in slowly. Aug. 1 was the date for some plans, including those covering numerous college students, but for most group plans, the key date will be Jan. 1, 2013. Moreover, existing plans are exempt from the requirement ("grandfathered"), so long as no significant negative changes, such as benefit reductions or cost-sharing increases, are made to them. Much of this complexity will clear up over the next year or two. The federal government has projected that most plans will lose grandfathered status by 2014.2 Other complications will persist, however, such as insurance formularies that could restrict the specific formulations and brands of contraception that will be covered without cost-sharing. As with countless other insurance minutia, many patients and healthcare providers will need to seek clarity from the health plan itself. Among other resources to help, the Washington, DC-based National Women's Law Center has created a guide for consumers to ask the right questions, along with telephone and email hotlines to report problems.3 (For information on ordering this guide, see Resource at end of article.)
Additional uncertainty comes in the form of ongoing conflict over the objection of some employers to providing or facilitating contraceptive coverage. In response to objections from religious groups and social conservatives opposed to contraception, the Department of Health and Human Services adopted a narrow exemption to the requirement for religious employers, limited to those that exist for the purpose of inculcating religious values and that primarily employ and serve people who share the employer's religion.1
Opponents decried that exemption as too narrow and demanded that a broader range of employers be exempted, including universities, hospitals, and social service organizations that are religiously affiliated but that serve and employ the general public. After weeks of controversy at the beginning of 2012, the Obama administration announced an additional "accommodation": It established a one-year "safe harbor," through August 2013, for religiously-affiliated nonprofit employers that do not qualify for the exemption and do not currently cover contraception, and it promised that additional regulations would be completed by that date to establish a work-around.4 The administration has promised to develop those regulations with input from religious employers and other interested parties. They would shift the obligation to third-party insurers and administrators to pay for, arrange, and communicate to employees about the contraceptive coverage, thereby divorcing the employer from any connection to it.5
The announced accommodation satisfied many of the requirement's more moderate critics, but anticontraception organizations and policymakers, led by the U.S. Conference of Catholic Bishops, have rejected it. Instead, they insist on a full repeal of the contraceptive coverage requirement or a sweeping exemption that would allow any entity, including private-sector business owners, to reject coverage for their employees of any service to which the employer has a religious or moral exemption. The U.S. Senate in March narrowly rejected such an exemption, proposed by Sen. Roy Blunt (R-MO).6
Opponents also have taken their fight to the courts. As of mid-September, more than two dozen lawsuits had been filed by a range of Catholic and evangelical Protestant employers challenging the contraceptive coverage requirement as a violation of their religious freedom. Several of the lawsuits brought by nonprofit groups have been dismissed as premature, because the safe harbor period and the promised accommodation mean that those employers might never be affected. In one other challenge, brought by a private-sector manufacturing company in Colorado that is not eligible for the safe harbor, a federal judge has granted a preliminary injunction against the requirement, meaning that it will not apply to that one employer while the case is being argued. Similar lawsuits against contraceptive coverage mandates in California and New York have been rejected in the past by those states' highest courts.
References
- Health Resources and Services Administration, Women's preventive services: required health plan coverage guidelines, 2011. Accessed at http://www.hrsa.gov/womensguidelines.
- U.S. Department of Health and Human Services (DHHS), Keeping the health plan you have: the Affordable Care Act and "grandfathered" health plans, 2010. Fact sheet. Accessed at http://1.usa.gov/qLDFpu.
- National Women's Law Center. Preventive services, including contraceptive coverage, under the health care law. Accessed at http://bit.ly/RIJltf.
- Center for Consumer Information and Insurance Oversight. Guidance on the temporary enforcement safe harbor for certain employers, group health plans and group health insurance issuers with respect to the requirement to cover contraceptive services without cost sharing under Section 2713 of the Public Health Service Act, Section 715(a)(1) of the Employee Retirement Income Security Act, and Section 9815(a)(1) of the Internal Revenue Code, Feb. 10, 2012, revised Aug. 15, 2012.
- Department of the Treasury, Department of Labor and Department of Health and Human Services. Certain preventive services under the Affordable Care Act, Fed Reg 2012, 77(55):16501–16508.
- Aizenman NC, Helderman RS, Birth control exemption bill, the 'Blunt amendment,' killed in Senate. Washington Post; March 1, 2012. Accessed at http://wapo.st/zRfvpL.
Resource
For more information on the new coverage, visit the NWLC web site, www.nwlc.org. On the left side of the page, select "Women & the Health Care Law", then "Find out more," to visit a page with links to free fact sheets such as "Contraceptive Coverage In the Health Care Law: Frequently Asked Questions," and online tools such as how to determine if and when a health plan will cover preventive services with no co-pay.
Throughout the first half of 2012, debate raged in Washington and in the media over a new requirement under the Affordable Care Act that most private health plans provide coverage of contraceptive methods and counseling without additional out-of-pocket costs, such as copayments and deductibles.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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