New era in women’s care

Fight over con­tra­cep­tive cov­er­age still un­set­tled

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jes­sica Zig­mond

Au­gust ush­ered in more ben­e­fits to con­sumers from pro­vi­sions in the health­care re­form law, in­clud­ing a con­tro­ver­sial re­quire­ment for con­tra­cep­tion cov­er­age tar­geted by sev­eral law­suits. At a Capi­tol Hill news con­fer­ence with Demo­cratic sen­a­tors last week, HHS Sec­re­tary Kath­leen Se­be­lius her­alded eight new pre­ven­tive health­care ser­vices for women that health plans must of­fer with­out a co­pay­ment or de­ductible as of Aug. 1. Ac­cord­ing to a re­port from HHS, about 47 mil­lion Amer­i­can women are in health plans that must now also cover a num­ber of ser­vices at no charge, in­clud­ing con­tra­cep­tion, well-woman vis­its and breast-feed­ing sup­port.

Se­be­lius also par­tic­i­pated in a Web dis­cus­sion about the ser­vices and com­mented on the con­tro­versy sur­round­ing con­tra­cep­tive cov­er­age. She noted that churches are ex­empt from the re­quire­ment and that reli­gious em­ploy­ers that raise ob­jec­tions—such as Catholic hos­pi­tals, a few of which are su­ing the ad­min­is­tra­tion over the rule—have one more year be­fore the man- date ex­tends to their work­ers. “But the em­ploy­ers won’t ever pur­chase or re­fer peo­ple or pay for the con­tra­cep­tion,” Se­be­lius said. “The man­date is re­ally on the in­sur­ance com­pany or the third­party ad­min­is­tra­tor.”

Days be­fore the pro­vi­sions be­came ef­fec­tive, a fed­eral judge in Colorado is­sued a tem­po­rary in­junc­tion to pre­vent the man­date from ap­ply­ing to Her­cules In­dus­tries, a Den­ver-based heat­ing and air-con­di­tion­ing com­pany.

“We are dis­ap­pointed with the court’s de­ci­sion to pre­lim­i­nar­ily en­join ap­pli­ca­tion of part of the women’s pre­ven­tive ser­vices pol­icy to this par­tic­u­lar for-profit com­pany in Colorado,” Se­be­lius said in a state­ment. “This law­suit was not brought by a reli­gious or­ga­ni­za­tion. Rather, it was brought by a for-profit com­mer­cial en­ter­prise whose pur­pose is to sell HVAC equip­ment. We are con­fi­dent that as this case moves through the courts, the pol­icy that most health in­sur­ance plans cover con­tra­cep­tion will be up­held.”

Mean­while, Aug. 1 also marked the dead­line for health plans to send re­bate checks to em­ploy- ers and con­sumers as a re­sult of the Pa­tient Pro­tec­tion and Af­ford­able Care Act’s med­i­cal-loss­ra­tio pro­vi­sion, which re­quires small-group and in­di­vid­ual health plans to spend at least 80 cents of ev­ery pre­mium dol­lar on med­i­cal care.

Ed­mund Haislmaier, a se­nior re­search fel­low in health pol­icy stud­ies at the con­ser­va­tive Her­itage Foun­da­tion, tes­ti­fied on the is­sue last year and plans to re­lease new re­search on the MLR this fall. He called the pro­vi­sion one of the “most back­ward” mea­sures in the 2010 law, which will lead to re­duced com­pe­ti­tion.

For in­stance, he said the mea­sure will fa­vor for-profit in­sur­ers and lead to con­sol­i­da­tion of health in­sur­ance mar­kets be­cause the re­quire­ment con­strains the share of pre­mium in­come that in­sur­ers can re­tain, which lim­its a com­pany’s ef­forts to gain the needed cap­i­tal to ex­pand. For­profit com­pa­nies can al­ways is­sue more shares to ac­quire cap­i­tal be­cause the pro­ceeds are not con­sid­ered pre­mium in­come.

Amer­ica’s Health In­sur­ance Plans said last week that the MLR reg­u­la­tion places an “ar­bi­trary cap” on what plans can spend on fraud and other pro­grams that im­prove safety.

And while em­ploy­ers or in­di­vid­u­als might re­ceive re­bate checks now, they could end up pay­ing higher pre­mi­ums in the fu­ture, Haislmaier said. Writ­ing re­bate checks is eas­ier than charg­ing pre­mi­ums that don’t cover costs and then try­ing to re­coup the dif­fer­ence, he added.

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