New York Protects Contraceptive Coverage Without Co-pays

Guest blog by Lois Uttley, MPP, Director, Raising Women’s Voices-NY.

More than 55 million women across the United States have gained contraceptive coverage without co-pays as part of their health insurance policies, because of the Women’s Preventive Services Amendment to the Affordable Care Act (ACA). This coverage benefit, which applies to most employer-sponsored insurance as well as to health plans purchased through ACA marketplaces, is estimated to have saved the average woman about $240 a year in avoided out-of-pocket costs.

However, research by Raising Women’s Voices-NY has consistently found that insurers offering plans in New York are not always complying with ACA birth control coverage requirements. (Similar problems have been found in other states.) RWV-NY wrote to state officials in 2014 and 2016 to cite numerous apparent violations of the contraceptive coverage rules by New York insurers. Problems identified included failing to cover some of the 18 FDA-approved methods of contraception – especially IUDs, the patch and emergency contraception – inappropriately charging co-pays for some contraceptives and giving inaccurate or confusing information to women who called health plan customer service lines.

This week, the Cuomo administration took action against one New York insurer – Excellus Health Plans – for illegally denying consumers contraceptive coverage, among other problems. The state Department of Financial Services (DFS) fined Excellus $1 million for these violations. That action underscored the Department’s intention to hold insurers accountable for providing contraceptive coverage without co-pays. DFS sent a circular letter to insurers back in January, reminding them of their obligation to comply with the birth control coverage requirements of the ACA, and asserting that New York law independently requires such coverage.

The Cuomo administration went even further to articulate and expand contraceptive coverage requirements in New York through a regulation proposed in January, just as women’s organizations were expressing concern about a new federal administration that could move to rescind the ACA contraceptive coverage benefit.  The new Secretary of Health and Human Services, Tom Price, has been an outspoken opponent of contraceptive coverage requirements and of the ACA as whole.

Both Health Care For All New York and Raising Women’s Voices-NY submitted comments in March supporting the proposed state contraceptive coverage regulation and suggesting ways to make the requirements even stronger, such as by including coverage of male contraceptive methods (vasectomies and condoms) and requiring insurers to cover dispensing of a 12-month supply of birth control pills at once (which has been shown to help women avoid gaps in contraceptive use caused by having to refill prescriptions).

HCFANY and RWV-NY are also supporting legislation – the proposed Comprehensive Contraceptive Coverage Act – that would place robust contraceptive coverage requirements into state law. The bill has passed the state Assembly, but has not seen action in the state Senate.

UrgentLate last month, the American Health Care Act (AHCA), which would have devastated the Medicaid program and left millions uninsured, was pulled from the House floor. According to an article in today’s New York Times, the majorities in Congress are discussing a proposal to move forward with the bill.

In addition to all of the harmful provisions in the original AHCA, the new proposal would eliminate community rating, which requires insurers to charge the same price regardless of health status, and the requirement that insurers cover a standard minimum benefits package, known as the Essential Health Benefits. These two changes would effectively get rid of the protections for people with pre-existing conditions and allow insurers to put annual and lifetime caps on payment for covered benefits.

There could be a vote to pass a new bill with these amendments as early as this Friday. Please call your Members of Congress at 844.898.1199 and tell them “Don’t take away our health care.”

Red AlertYesterday, Members of the House of Representatives introduced Affordable Care Act (ACA) repeal and replacement legislation in the Ways and Means and Energy and Commerce Committees. According to a blog post from Health Affairs, the committees will begin markup of the bills tomorrow, March 8, and the House is hoping to pass a repeal and replacement bill in the next three weeks.

The two bills would not repeal the ACA entirely. They would leave in place many of the ACA’s insurance reforms including: coverage for people with pre-existing conditions; guaranteed availability of coverage; coverage of young adult children under their parents’ health plans until age 26; and annual out-of-pocket maximums. The bills would also leave in place certain consumer protections including the ban on discrimination on the basis of race, nationality, disability, age, or sex.

However, there are a number of provisions in the two bills that would harm consumers. These include:

Gutting Medicaid

  • Medicaid would be transitioned to a per capita cap program by 2020. This means that the federal government would provide a fixed amount of money to each state per enrollee, rather than a percentage of the total costs per enrollee.
  • Federal funding for Medicaid expansion would be eliminated.
  • States would be provided incentives to re-determine Medicaid eligibility more frequently. In New York, many Medicaid enrollees have 12-month continuous Medicaid coverage.

Undermining Coverage Gains

  • Individuals would no longer face a tax penalty for not having coverage. Instead, premiums would go up by 30 percent as a penalty for consumers who do not maintain continuous coverage during the 12 months preceding enrollment in a new plan.
  • Employers would no longer be penalized for not offering coverage to their employees and dependents.

Eroding Marketplace Affordability

  • States would be allowed to charge older consumers premiums 5 times greater than those of younger consumers. Currently, insurers are only allowed to charge only consumers 3 times as much as younger consumers.
  • The current income-based advanced premium tax credits would be replaced with tax credits based on age. This means that a low-income consumer would receive the same tax credit as a wealthy consumer in the same age bracket.
  • Cost-sharing reductions for eligible consumers with incomes under 250 percent of the Federal Poverty Level would be eliminated after 2019.
  • Plans sold through the Marketplace would provide less coverage for health services, and consumers would be responsible for more out-of-pocket costs.

Reducing Access to Family Planning Services

  • Planned Parenthood would lose federal funding for one year if the bills become law.

New York Representatives Chris Collins and Paul Tonko serve on the Energy and Commerce Committee, and Representatives Tom Reed and Joe Crowley serve on the Ways and Means Committee. If you or someone you know would be affected by the changes proposed in these two bills, please call your elected Representatives today at 1-866-426-2631.

ProtestJoin members of New York City’s Congressional delegation, City officials, New York health care providers, advocacy groups and patients this Saturday morning at 11:00 AM at Gouverneur Health Auditorium, 227 Madison Street, on the Lower East Side of Manhattan to oppose efforts to dismantle the Affordable Care Act (ACA).

This rally comes on the same day that members of the House across the country are calling for a “National Day of Action” to oppose efforts to “Make America Sick Again.”

We hope to see you there!