Women’s health advocates were thrilled when the Affordable Care Act became law in 2010, because it required insurance companies to cover a broad array of women’s health services at no additional out-of-pocket cost beyond premiums.
Five years later, however, that requirement is not being enforced, according to two new studies. Health insurance plans around the country are failing to provide many of those legally-mandated services including birth control and cancer screenings.
The studies by the National Women’s Law Center looked at health plan coverage documents and consumer complaints in 15 states. One of the studies focused on contraception, while the other looked at a range of women’s health issues, including maternity care, breast-feeding support and other services.
“We found some very clear violations of the law,” said Karen Davenport, the group’s director of health policy. Among the companies named as not complying with the law’s requirements in at least some states are Aetna, Cigna, Physicians Plus and Anthem Blue Cross Blue Shield.
For example, Physicians Plus, a plan offered in Wisconsin in 2014, limited coverage of prenatal vitamins to women under the age of 42. And several companies in the study refused to provide coverage for birth control for women over age 50, despite the fact that many women are able to get pregnant long after that.
The report on required coverage of birth control found numerous instances where health plans impermissibly try to impose cost-sharing on all except generic products. There are, however, no generic intrauterine devices, and in some cases women have a medical need for brand-name products. Many plans in the study also failed to cover costs associated with birth control, such as follow-up appointments, researchers found.
One woman in Washington D.C., who complained to the organization’s “CoverHer”hotline, said she was told her IUD would be covered, then, after it was inserted, her claim was denied. “The insurance company says I can appeal their decision by writing a letter telling them how the decision ‘made me feel,’” she said, according to the report.
The study’s authors called for more and better enforcement of the rules regarding women’s health coverage. “We don’t need legislation,” said Sharon Levin, who runs the group’s reproductive health policy program. “We have that. We need better enforcement.”
The insurance industry disputed the reports’ conclusion that the problem is widespread. “This report presents a distorted picture of reality,” said Karen Ignagni, President and CEO of America’s Health Insurance Plans, the industry’s primary trade group. “Health plans provide access to care for millions of women each day and receive high marks in customer satisfaction surveys. To use highly selective anecdotes to draw sweeping conclusions about consumers’ coverage does nothing to improve the quality, accessibility, or affordability of health care for individuals and families,” Ignagni said.
Researchers examined publicly available documentation for more than 100 separate policies in 15 states for plan years 2014 and 2015, including plans in states running their own insurance exchanges and those using the federal HealthCare.gov. It found that more than half of the plan documents described coverage at odds with the health law.
The findings in the birth control report are similar to those in a report released earlier this month by the Kaiser Family Foundation. That study looked at 20 insurance carriers in five states and found that almost all the plans limited access to some forms of birth control in some way, either by not covering them at all or by charging a copay. (Kaiser Health News is an editorially independent program of KFF.)
One source of confusion is the fact that under federal implementation guidelines, insurance plans may use so-called “medical management” techniques that are aimed at keeping overall costs (and premiums) down.
But Levin said it remains unclear what counts as “acceptable” medical management tools. Some plans, she said, count any contraceptive that uses hormones as a single method. That lumps together pills, patches, and vaginal rings, and then covers just one generic version of the treatment. Yet the law requires plans to make available all FDA-approved methods of birth control without cost-sharing. “We need better clarification” from the federal government, she said.
In at least some cases, consumers and advocates complained to insurers and policies were changed. “Calling and complaining to your insurance company works,” said Levin, noting that Aetna has reversed a decision not to cover the vaginal ring.
–Julie Rovner, Kaiser Health News
Merrill Shapiro says
Flagler County women are too smart to vote for Republicans who blabber about life’s sanctity while denying women the right to control over their own bodies and then complain about government interference!
Tom Jacks says
Turnabout is fair play. Obama says congress be damnened, the constitution be damnened, I’ll do what I damn well please. It’s time his opponents play by his rules.
Obama 2015 says
Fine and sue them.
Sherry E says
Right On Merrill!
So typical of insurance companies to take out the microscope and do everything they can to continue to maximize their profits by spending big bucks finding illegal loopholes instead of doing the “right thing” by their policyholders. . . AND our self righteous conservative (majority white men) legislatures simply look the other way. . . no problem as long as their Viagra is covered!!!
Lancer says
0bamacare, of which 85% of the enrollees are “supplemented” by taxPAYERS, solely voted on by one party, think they should do as they damn well want?? Talk about an oxymoron.
If you want “choice”, support yourselves and quit being dependent.
Sherry…these are the same insurance companies 0bama promised to pay for supporting his horrible bill! Further, you state that “conservatives are looking the other way”? Maybe you should visit Detroit, or better yet, Baltimore as to what happens to cities where Democrats “look the other way”.
a tiny manatee says
I think cutting social security and medicare would be a good start when it comes to reducing this ridiculous tax load that I as a taxpayer am required to pay, because it’s filled with people that are looking for government handouts and don’t want to work.
Sherry E says
Get educated! Social Security and Medicare are for elderly tax payers based on what they involuntarily personally paid into those systems during all the years they worked their asses off! Those programs are certainly NOT about people looking for government handouts!!!!
a tiny manatee says
The money they paid into the system paid for people on social security at the time they were paying into the system.The money I pay in taxes pays for people on social security right now. If you’re going to complain about people leeching off of taxpayers, the first place to look is at social security and medicare. Both of these programs are filled with people leeching off of taxpayers that could instead be working.
Sherry E says
@Tiny Manatee although you may not believe it now, there hopefully will be a time when you will reach your own 60s, 70s, and 80s and be able to retire. Expecting the elderly to work until the day they die, especially when employers will not continue their employment/hire them . . . then labeling them as “leeching off tax payers” is outrageous and completely bigoted!!! May you never need assistance from your community and your neighbors, as you are attracting misfortune into your life and will have no where to turn.
Have a blessed day. . . you are going to need it!
Sherry E says
@ Lancer . . . if you ever really want me to read and give any thought at all to your comments, please include actual “factual” information from a “credible” source. Otherwise, I will continue to consider them Limbaugh laced smoke that only belongs “where the sun doesn’t shine”.
Sincerely, this Woman who doesn’t suffer fools gladly!
Nancy N says
You seem to be of the impression that people receiving ACA subsidies are unemployed and sponging off the government. To the contrary, to qualify for ACA subsidies there are actually MINIMUM income levels that must be met – something like 150% of poverty level – which of course means that recipients must be working to earn that income. Below that minimum, people are supposed to be on the Medicaid expansion under the ACA law and so can’t receive ACA subsidies. So if they are receiving subsidies, they de facto must be working and supporting themselves – just not well enough to afford health insurance, which can cost more than a mortgage payment for a small family. For a family of 4, the subsidies extend (on a sliding scale) up to an income of something like $90,000/year. Saying someone is receiving a subsidy doesn’t mean they are unemployed and living off the government. It could be a family of 4 with an income of $85k per year receiving a small tax credit. A large percentage of Walmart’s workers receive subsidies through the exchange. My own family receives a subsidy as well, and both my husband and I are employed.
And of course a large portion of Obamacare enrollees are supplemented by the government. The entire point of the program was to bring health insurance to people who couldn’t access or afford it before! If you could afford private insurance already, or had it through your employer, you don’t need the exchange! The exchange program was set up largely for the purpose of delivering subsidies to people.
Women aren’t asking to be able to “do as they damn well want”. They are asking for the health services they are entitled to by law to protect their health. Despite what the GOP would have you believe, corporations are not exempt from the laws of this country. You may not like that law (although your opinion is obviously based on misinformation and flat-out lies you’ve been told) but it is still the law.
Perhaps you should actually educate yourself about the law and what it does from some source besides Limbaugh and Faux News so you can learn some facts instead of political propaganda.
Lancer says
…and social security?
http://www.cnbc.com/id/102659216
Sherry E says
Congress is very actively working on Social Security reform:
Estimate of the Financial Effects on Social Security of H.R. 2135, “Promoting Opportunity for Disability Benefit Applicants Act“ legislation introduced on April 30, 2015 by Representatives Charles Boustany and Sam Johnson (PDF version)
April 23, 2015 DeFazio, Peter Estimates of the Financial Effects on Social Security of H.R. 1984, the “Fair Adjustment and Income Revenue for Social Security Act,“ legislation introduced on April 23, 2015 by Representative Peter DeFazio (PDF version)
March 26, 2015 Sanders, Bernie Estimates of the Financial Effects on Social Security of S. 731, the “Social Security Expansion Act,” legislation introduced on March 12, 2015 by Senator Bernie Sanders (PDF version)
March 18, 2015 Larson, John Estimates of the Financial Effects on Social Security of H.R. 1391, the “Social Security 2100 Act,” legislation introduced on March 17, 2015 by Representative John Larson (PDF version)
February 12, 2015 Johnson, Hatch Estimates of the Financial Effects on Social Security of H.R. 918 “The Social Security Disability Insurance and Unemployment Benefits Double Dip Elimination Act of 2015” introduced on February 12, 2015 by Representative Sam Johnson, with similar Bill introduced in the Senate by Senator Orrin Hatch (PDF version)
February 5, 2015 FY2016 Budget Potential Reallocation of the Payroll Tax Rate Between the Disability Insurance (DI) Program and the Old-Age and Survivors Insurance (OASI) Program (PDF version)
February 2, 2015 Barack Obama Estimates of the Financial Effects on Social Security of the President’s Executive Actions for Immigration Announced November 20, 2014, requested by Senator Ron Johnson (PDF version)
November 13, 2014 Kevin Brady Estimates of the Financial Effects on Social Security of H.R. 5697, the “Equal Treatment of Public Servants Act of 2014,” legislation introduced on November 13, 2014 by Representative Kevin Brady (PDF version)
July 31, 2014 John Larson Estimates of the Financial Effects on Social Security of the “Social Security 2100 Act,” legislation introduced on July 31, 2014 by Representative John Larson (PDF version)
July 28, 2014 N/A Potential Reallocation of the Payroll Tax Rate Between the Disability Insurance (DI) Program and the Old-Age and Survivors Insurance (OASI) Program (PDF version)
June 10, 2014 Begich, Murray Estimates of the Financial Effects on Social Security of the “Retirement and Income Security Enhancements Act,” legislation introduced on June 10, 2014 by Senators Mark Begich and Patty Murray (PDF version)
March 4, 2014 FY2015 Budget Estimates of the Financial Effects on Social Security of a Proposal to Reduce DI Benefits Based on Receipt of UI Benefits (PDF version)
January 7, 2014 Sam Johnson Estimated Financial Effects on Social Security of H.R. 1502 (Social Security Disability Insurance and Unemployment Benefits Double Dip Elimination Act), requested by Representative Sam Johnson (PDF version)
January 7, 2014 Tom Coburn Estimated Financial Effects on Social Security of S. 1099 (Reducing Overlapping Payments Act), requested by Senator Tom Coburn (PDF version)