whatNOW - Fall 2011 e-Newsletter New Rules Mandate Preventive Care for Women Without Copays By Katharine Davis
In August, the US Department of Health and Human Services (HSS) brought access to preventive care one step closer to reality for low- and middle-income women. New guidelines from the agency mandate that as of August 1, 2012, all new health insurance plans must cover certain preventive services, including contraception, without requiring copayments, coinsurance, or deductibles.
To lower the burden of chronic diseases, which are currently responsible for 7 in 10 deaths among Americans, one of the goals of the Affordable Care and Patient Protection Act of 2010 was to make preventive care more accessible. When the Act was passed last year, it stipulated that recommended preventive screenings be covered by new health insurance plans at no additional cost to the plan holder. The list of covered services, based on recommendations from the US Preventive Services Task Force and the Centers for Disease Control, included mammograms and Pap smears but did not cover many of women's other unique health-care needs. Recognizing this, lawmakers included in the Act a provision that empowered the HHS to approve additional covered services. The agency commissioned the Institute of Medicine (IOM), an independent panel of medical experts, to advise it on what should be covered.
After reviewing the scientific evidence for a variety of preventive services, the IOM released its report in July of this year. On August 1, the HHS announced its approval of the recommendations.
As of August 2012, health insurance plans must cover the following services without cost sharing:
• All Food and Drug Administration-approved contraceptive methods and counseling, including birth control pills, intrauterine devices (IUDs), and diaphragms
• Annual well-woman visits, including recommended screenings and preconception and
prenatal care
• Screening for gestational diabetes in pregnant women
• Breast-feeding counseling and equipment
• High-risk DNA testing for human papillomavirus (HPV), a common cause of
cervical cancer, every three years
• Annual counseling for sexually transmitted infections
• Annual screening and counseling for interpersonal and domestic violence
Calling the new guidelines "a historic step toward addressing women's unique health care needs," NOW-NYC Deputy Director Jean Bucaria said they are a win for women because they "expand women's access to preventive care, make contraception affordable with insurance, and recognize antiviolence measures as a critical part of women's health."
Research has shown that even modest cost sharing deters many women from receiving the preventive services they need. In a 2009 survey, the Guttmacher Institute found that 30% of women who were financially worse off because of the recession had put off a family planning visit to save money. By removing cost barriers, the changes have the potential to significantly improve women's health.
NOW-NYC, alongside other women's advocacy organizations, had been focused on securing expanded coverage for contraception. NOW-NYC Executive Director Sonia Ossorio said, "You'd think that expanding coverage for birth control would be straightforward, but it wasn't. We needed more studies, more experts, more comment periods, more voices-all to support what has been obvious to women and the medical community for years."
The new rules have two important caveats. First, they allow the HHS to grant religious employers an exemption to the requirement about contraception coverage. Because such exemptions would be at the department's discretion, it is unclear how many women would remain without access as a result.
Second, the rules do not apply to plans that are considered "grandfathered" under the Affordable Care Act. A grandfathered plan is one that existed before March 23, 2010, and that has not made significant cuts to existing benefits or increased beneficiaries' out-of-pocket spending. You can ask your employer whether your plan has grandfathered status.
The new rules issued by the HHS are so-called "interim final rules," meaning the agency is putting them into effect but simultaneously leaving them open for comment. They have the potential to be revised in the future. NOW-NYC is calling on individuals to submit comments in support of the rules.
Take Action!Submit a public comment on the rules. For sample comments and more info to get you started, visit “Take Action to Support HHS Rules!” Note: If you have trouble with the above link go to www.regulations.gov by September 30 and search for document ID: HHS-OS-2011-0023. Click double arrow at bottom of page to get to Rules and click “Submit a Comment” on the right hand side. Learn More!Reproductive Rights | NOW-NYC's Press Release | HHS Press Release
Preventive Care Info Central at RWV | Expanded Care for Women
IOM Findings Discussed | Read more about this historic recommendation.
| Fighting Fire With Facts When the IOM released its report about necessary preventive services for women in July, the recommendation to eliminate cost sharing for contraception ignited a firestorm among conservatives and the religious right. Opponents of birth control sounded vehemently sexist and nonsensical arguments against expanded access, including that it will turn nice girls into loose women, encourage abortion, and amount to racial and lower-class “genocide.” If you find yourself going toe-to-toe with an opponent of contraception access, consider pointing out the following facts.
· The new rules do not amount to “free” birth control. Although copays are eliminated, women must still pay health insurance premiums.
· Contraception coverage is not new. Most group health insurance plans already cover it. In fact, New York State is one of 27 states requiring health insurance plans that cover prescription drugs to include contraception.
· 99% of women who have had sex have used contraceptives at some point. It’s already a near-universal practice.
· Half of pregnancies among American women are unplanned. Of unplanned pregnancies, 4 in 10 end in abortion. Preventing unplanned pregnancy prevents abortions.
· Contraception is estimated to save $19 billion a year in costs related to unplanned pregnancies. Increasing access will increase savings.
· Contraception supports and improves women and children’s health outcomes by enabling women to plan the spacing and timing of their pregnancies. It is also used to address health issues such as preventing ovarian cysts or endometrial and ovarian cancers.
· Opponents of contraceptive coverage are in the minority. In a recent NPR–Thompson Reuters poll, 77% of respondents said that private insurance plans should cover some or all of the cost of birth control pills. If the plan is subsidized by the government, 74% of respondents thought it should cover some or all of the cost.
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