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.

RulesFollow up from blog posted February 21, 2017

Yesterday afternoon, the Centers for Medicare and Medicaid Services (CMS) issued a final rule claiming to stabilize the Affordable Care Act insurance markets. In fact, it does just the opposite.

HCFANY and thousands of other consumer and provider groups submitted comments in opposition to the proposed version of the rule because many of its provisions would have harmed consumers. However, the rule was finalized largely as proposed.

The final rule reduces the open enrollment period for individual and small group health insurance plans from 13 weeks to just six weeks, which gives consumers significantly less time to shop around for and enroll in the best plan for them.

The final rule also decreases the allowable actuarial values for health plans at each metal level, which could reduce the advanced premium tax credits (APTCs) that help make health plans purchased through the Marketplace more affordable for moderate-income individuals and families. According to an analysis from the Center on Budget and Policy Priorities, even a 2 percent decrease in actuarial value could result in a $327 reduction in APTCs for an individual.

The final rule will make it more difficult for consumers to qualify for and enroll in health coverage through special enrollment periods, which could lead to gaps in coverage and deter enrollment.

Currently, it is unclear how this rule will affect New York because state officials are still studying it closely. Come back to HCFANY next week for more information.

HCFANY worked hard this year on a series of important priorities during this budget session. Governor Cuomo’s statement on the final enacted budget can be found here.

Here is a quick summary of how we did:

Full funding for Community Health Advocates (CHA)

HCFANY Recommendation: Provide $4.75 million in funding for CHA to help people and small businesses obtain, use, and keep their health insurance coverage.

Result: The final budget included $3.5 million for CHA – $2.5 million from the Executive and $1 million from the Assembly. The total funding is an increase of $250,000 from the past year.

Expansion of Child Health Plus (CHP) to Age 29

HCFANY Recommendation: Increase the age limit for CHP from 19 to 29 to create an affordable coverage option for young adults who are not eligible for subsidized health insurance because of their immigration status.

Result: This measure was not included in the enacted budget.

Essential Plan Premiums and Cost-Sharing

HCFANY Recommendation: HCFANY opposed increasing premiums and cost-sharing for consumers enrolled in the Essential Plan (EP), New York’s Basic Health Program for consumers with incomes just above the Medicaid limit.

Result: There were no changes to EP premiums, and there will be no increases in cost-sharing through at least March 2018.

Medicaid Beneficiary Protections

HCFANY Recommendation: HCFANY opposed the following threats to Medicaid beneficiaries: (1) increase in copayments for preferred, non-preferred, and over-the-counter drugs; (2) elimination of spousal/parental refusal, a reduction of resources that spouses and parents of people in managed long-term care or nursing homes can keep; and (3) repeal of “prescriber prevails.”

Result: (1) The budget increased copayments for preferred prescription drugs from $1 to $2.50 and decreased copayments for non-preferred drugs from $3 to $2.50. There were no changes to copayments for over-the-counter drugs; (2) there were no changes to spousal refusal; and (3) there were no changes to “prescriber prevails.”

Enhanced Reimbursement for Safety Net Hospitals

HCFANY Recommendation: Provide an enhanced reimbursement rate for hospitals that: (1) have at least 50 percent Medicaid or uninsured patients; (2) have at least 40 percent of inpatient discharges covered by Medicaid; (3) have no more than 25 percent of patients commercially insured; and (4) are facilities that are part of the state’s five public health systems or federally designated as critical access or sole community hospitals.

Result: The final budget includes $40 million for safety net hospitals that meet the criteria above for fiscal year 2018.

Health Care Regulation Modernization Team

HCFANY Recommendation: Designate at least 20 percent of the seats on this team for health care consumers or advocates and require consumer representation on all team subgroups. Limit the team’s role to making recommendations that would then be taken up by the legislature.

Result: The Health Care Regulation Modernization Team was not included in the final enacted budget.

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.”