Women's health advocates cheered Monday after the Obama administration issued an unambiguous statement that said health insurers can't impose cost-sharing for approved birth control methods.
“It's extremely helpful because there really was a problem that needed fixing,” said Susan Wood, the director of the Jacobs Institute of Women's Health at George Washington University.
The business community also welcomed the clarification. Insurance companies said the guidance—which clarified other insurance issues such as testing for cancer—would help ensure their policies conform to Affordable Care Act standards.
Under the ACA, preventive services such as contraception and wellness visits have to be covered by health insurance companies for free. However, studies from the Kaiser Family Foundation and the National Women's Law Center last month found that many insurers were violating ACA policy by charging people co-payments and other out-of-pocket costs for contraceptive products and services.
New guidance issued by HHS, the departments of Labor and Treasury (PDF) said all health insurers must cover the 18 birth control methods approved by the Food and Drug Administration—including the vaginal ring, patch and intrauterine devices—with zero cost-sharing borne by the member.
“These two studies that just came out made it crystal clear that it wasn't just a small problem or a very limited problem, but that it was widespread,” Wood said. Wood also served as the FDA's assistant commissioner for women's health from 2000-2005. She resigned from her position in 2005 after the FDA delayed approval of the contraceptive pill Part B for over-the-counter sales.
The National Women's Law Center said in its April report that despite ACA rules, women in every state in the country reportedly had to pay for their birth control depending on their health plan and carrier. The not-for-profit group said the government's decision would keep business practices in line with the law.
“It is past time for insurers to adhere to the law and stop telling women that their chosen method isn't covered or that they must pay for it,” Gretchen Borchelt, a vice president at the National Women's Law Center, said in a statement. “We welcome the administration's guidance and know it will go a long way to improve the health and economic well-being of women and their families.”
Insurance companies have said their coverage of contraceptives is part of their “medical management” strategy, which pushes members to use the most cost-efficient and effective methods available. But the new guidance makes it clear that all health plans have to provide women with access to any approved birth control method that fits their needs.
“Today's guidance takes important steps to support health plans' use of medical management in providing women with safe, affordable healthcare services,” America's Health Insurance Plans CEO Karen Ignagni said in a statement. AHIP is the primary lobbying group for private health insurers. “Health plans are committed to promoting evidence-based decision-making and to ensuring all consumers understand how their coverage works.”
Although birth control headlined the federal government's announcement, other issues were made clearer. For instance, the feds said all health insurers must cover preventive screenings, genetic counseling and genetic testing for BRCA genes without cost-sharing, if women have an increased risk of harmful mutations. BRCA1 and BRCA2 mutations are associated with higher risks of breast and ovarian cancer.
Insurers also cannot limit preventive services for transgender people, with the government saying insurers should defer to providers for medically appropriate coverage.
