Insurance Companies Blatantly Ignore ACA's Free Birth Control Mandate

Not only are insurance companies across the country flouting the Affordable Care Act's (ACA) birth control coverage mandate, they are violating a slew of other women's health requirements related to maternity care and more, the National Women's Law Center charged in dual reports released this week.

"Insurance companies are breaking the law by denying women coverage to which they are entitled," NWLC vice president for health and reproductive rights Gretchen Borchelt said in a statement. "The Affordable Care Act has made dramatic improvements in women's health coverage, but insurers' failure to comply with its requirements has serious consequences that affect women every day."

In State of Birth Control Coverage: Health Plan Violations of the Affordable Care Act (pdf), NWLC looked at coverage of FDA-approved birth control methods--which the ACA says must be covered without co-payments or deductibles--and found widespread violations nationwide.

Through its hotline, CoverHer, which women can call when they face problems accessing the birth control benefit to which they are entitled, the NWLC has reportedly heard from women in every state in the country.

In addition, NWLC reviewed over 100 plan documents from companies offering plans on the new marketplaces in 15 states, as well as publicly-available information on insurance company websites, and corresponded with insurance companies directly. This research uncovered three major trends in the ways insurance companies are not complying with the birth control benefit:

• Insurance companies are still not providing coverage for all FDA-approved methods of birth control, or they impose out-of-pocket costs on them;
• Insurance companies limit their coverage to generic birth control;
• Insurance companies fail to cover the services associated with birth control without out-of-pocket costs, including counseling or follow-up visits.

A plan in South Dakota, for example, does not cover the contraceptive implantable rod, while several major insurance companies fail to list the contraceptive patch or vaginal ring as drugs covered without out-of-pocket costs. An issuer in California fails to cover ella, an emergency contraceptive method; 10 issuers in Maine, Minnesota, Ohio, Rhode Island, and Wisconsin exclude all over-the-counter contraceptive methods; and several independently operated insurance companies impose impermissible 'generic only' coverage policies, including in Alabama and Florida.

Such policies are out of step with American healthcare realities, the NWLC stated, noting that "[p]rior to the ACA's birth control coverage benefit, cost was a significant barrier to women getting preventive services like birth control," which in turn contributed to the U.S. unintended pregnancy rate and "had consequences for women and their families' long-term health and economic well-being."

Since the ACA's birth control requirement went into effect in August 2012, more than 48 million women no longer face cost barriers to accessing birth control, according to the report, which continued:

Women have told the National Women's Law Center ... that this change has significantly affected their lives. They are no longer choosing between birth control and paying for other necessities, like groceries, and are continuing their education and advancing their careers because of this landmark law. Indeed, access to birth control has benefits for the health of women and children, improves women's ability to control whether and when they will have a child, and fosters women's ability to participate in education and the workforce on an equal footing with men.

Meanwhile, a separate NWLC report, State of Women's Coverage: Health Plan Violations of the Affordable Care Act (pdf), assessed how insurance companies are meeting other women's health coverage requirements set out by the ACA.

Focusing on coverage areas it deemed "of particular importance to women, including preventive services such as birth control, well-woman visits, and lactation supports; prenatal and maternity care; abortion services; and exclusion policies," the Center found many additional violations.

For instance:

• Fourteen issuers across seven states offer maternity coverage that does not comply with the ACA, the investigation revealed, posing "serious threats" to women and newborns;
• Twenty issuers in six states offer coverage of breastfeeding support and supplies that does not comply with the ACA, including limitations on breast pumps and lactation counseling;
• Ninety-two issuers in 12 states explicitly exclude care related to gender transition for transgender individuals.

What's more, the report stated, "the extent of the violations indicates the problems are likely to be systemic nationwide." Which is why the NWLC recommends that insurance companies as well as state and federal regulators step up both compliance and enforcement.

To that end, The Hill reports that Sen. Patty Murray (D-Wash.), who joined NWLC at a press conference announcing the release of the reports, "already sent letters to eight health insurance companies in her home state on Tuesday, raising concerns about the lack of compliance on the rule after other reports made similar findings."

Calling for more aggressive oversight, and better redress for affected consumers, NWLC's Borchelt declared: "Insurance companies must comply with the law, and regulators should do a better job enforcing it. Otherwise, women will again be at the mercy of insurers whose previous discriminatory practices drove the need for reform in the first place."