New era in women’s care
Fight over contraceptive coverage still unsettled
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.