As we’ve been sharing, this summer, the Institute of Medicine (IOM) is expected to make its recommendations to the Department of Health and Human Services (HHS) about which preventive health care services should be covered by all new health insurance plans without a co-pay or other out-of-pocket costs. Later this summer, HHS will announce what will be included based on these recommendations – and we are working hard to make sure that prescription birth control is included.
Women need access to birth control to prevent unintended pregnancies, plan the timing and size of their families and protect their health. Women know the preventive health benefits of birth control, but we also know the cost to stay on it throughout our childbearing years. Birth control can be expensive, and the high cost of birth control can affect whether women use it consistently.
Some insurance companies are violating the law by offering women incomplete health coverage under the Affordable Care Act (ACA), according to two new reports from the National Women’s Law Center (NWLC).
The ACA was designed to end the practice of forcing women to pay more for their insurance simply because they are women. The health law required insurers to cover maternity care, and to charge no copays for preventive services like birth control, breastfeeding support, and well-woman visits.
But in a survey of more than 100 insurers in 15 states, NWLC found a wide range of violations to the law.
These violations are making some women pay more for health care than they should, the report says, and could jeopardize health outcomes for women or their infants. Insurance companies also failed almost across the board to offer adequate coverage for transgender people.
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The NWLC findings on birth control echo those of the Kaiser Family Foundation just a few weeks ago. Both organizations found that, in violation of the law, some insurers only cover generic birth control pills or aren’t fully covering non-pill birth control methods like the vaginal ring or IUD. NWLC found that some plans improperly charge for services like family planning counseling or follow-up appointments after an IUD insertion.
Both also found that despite the ACA’s requirements, no companies reviewed had a clear waiver process for women who need a specific birth control method that isn’t covered under their plan. Women are told to go through the agency’s existing claims processes, which either don’t solve the problem or take too long for such a time-sensitive medical need.
NWLC, along with the insurance plans they reviewed, heard from women in all 50 states through their national hotline:
These women have spent hours on the phone with their insurance company trying to find out why they still have to pay for their birth control. They often are given conflicting information about their coverage by the insurance company. And, too often, the insurance company tells them their method of birth control simply is not covered, or that they should switch birth control methods if they do not want to pay out-of-pocket for the method prescribed for them.
A total of 33 insurers out of more than 100 plans NWLC surveyed, in 13 out of the 15 states, had some kind of birth control coverage violation.
A handful of insurers across seven states denied women the full range of maternity coverage that they’re entitled to, which can “pose serious threats to women and newborns” if women forgo essential prenatal care due to high costs, the report says.
The United States has higher rates of preterm birth and infant mortality than other developed countries, and it’s also the only advanced economy in the world in which maternal mortality rates are rising.
Five insurers in three states—Colorado, South Dakota, and Alabama—broke the rules by limiting a woman’s number of ultrasounds or prenatal visits, restricting coverage based on age, or refusing to cover certain prenatal screening tests.
Two insurers in Tennessee and Ohio refused to cover maternity care for dependents. The ACA explicitly prohibits this since so many women of reproductive age are covered through a spouse or parent.
Six plans in three states deny maternity coverage outside of the plan’s service area, which would leave women who go into early labor while traveling without options.
Twenty plans in six states didn’t adequately cover breast pumps or breastfeeding counseling. Some didn’t cover the services at all, and some imposed things like time limits on how long a breast pump could be rented.
By far the most widespread violation was failing to cover transgender people, which breaks rules against discrimination based on sex, gender identity, or health condition. In 12 of the 15 states studied, 92 insurers explicitly excluded services or surgery related to gender transition.
And even though abortion coverage is severely limited under the ACA, Colorado still managed to violate the law by refusing to cover any abortion services for women who receive financial help with their premiums.
The NWLC report authors note that, given how extensive all of the different violations were in this sample, it’s likely that insurers in other states are also failing to live up to their obligations to women.
The violations may be honest mistakes and miscommunications, or they may be deliberate efforts to avoid paying for care. Either way, the reports say, federal and state regulators need to get better at enforcing the law and informing women of their rights, and insurers need to be much more transparent about the coverage they offer.
Fordham University prohibits the prescription of contraception at its health centers and the distribution of condoms on campus though many students aren't aware of that until they've paid for the school's insurance or visited the health center. Many are denied birth control even when facing health risks. This week, law students at the Catholic school are taking matters into their own hands by organizing a clinic just off-campus.
See all our coverage of the Birth Control Mandate 2011 here.
A coalition of Fordham Law student groups has organized a birth control clinic just off campus that will take place this Wednesday. Though you wouldn’t know it from the university website and insurance materials that explain our health plan covers contraception as mandated by New York law, our Catholic university prohibits the actual prescription of contraception at its health centers.Students with university insurance must get our primary care and annual exams on campus or incur extra costs, and since the health center won’t prescribe it, that means extra costs for birth control.The distribution of condoms on campus is prohibited as well, though this rule is also not available in writing.
The Fordham chapter of Law Students for Reproductive Justice first asked the university for documentation of its policies eight months ago. We were planning a panel with Catholic theologians to discuss the doctrine behind the university’s policies on contraception, but we couldn’t find out what those policies are. The panel happened even though we never got the documentation.
Students often learn that the health centers have religiously-based prohibition on contraceptive care only after purchasing university health insurance or seeking care. The university’s position seems to be “What do you expect this is a Catholic school?” Well, I knew I went to a Catholic school, but I didn’t know I went to that kind of Catholic school. And, other students don’t know about the Catholic aversion to birth control or don’t expect it to affect health care for a religiously-diverse student population.
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Furthermore, our undocumented contraception ban lacks a health exception. Administrators and health center staff claim there is one, but in practice it does not exist. One student with endometriosis was prescribed painkillers instead of birth control pills. A student with irregular periods and a sonogram of an ovarian cyst was refused contraception as well. Another student offered her medical records to prove she had had both an ovary and an abdominal mass removed and was at high risk of ovarian cancer. Before she could obtain a prescription for the pill, she was told to get a letter from her doctor, who is across the country and charges a $25 fee for such letters.
Students are of course free to see a doctor off-campus, but under their university insurance plan they will incur a $100 “per condition” deductible; this is in addition to the cost of an annual exam they already had at the university health center. In many cases, students don’t learn about about the school’s policies and these hidden costs until they are shivering in a paper dress on the table in a doctor’s office. Students on tight budgets who want birth control have resorted to various workarounds. When health center staff refused to administer a Depo-Proverashot to a student, she had a friend of a friend who was an acupuncturist do it. Another had her medical resident boyfriend write her a prescription, though he had no experience in women’s health. Most often, however, students get their medical care at Planned Parenthood, an organization perennially at risk of funding cuts whose resources are needed by uninsured and low-income patients.
We decided to organize the clinic after we got tired of writing and discussing and asking nicely for the policies. The clinic is a way to address the expense and inconvenience that result from the policies and to make unknowing students aware that the university provides non-standard health care. It is also an opportunity to discuss the significant but under-recognized influence on women’s health of Catholic leaders far outside the lay Catholic mainstream.
Doctors from the Institute for Family Health were more than happy to help us with our clinic but it hasn’t been easy to pull off. University administrators forbid us from having the doctors come to campus and have limited our ability to advertise to students. We rented a space, but lost it unexpectedly and had to scramble to find another. It is unclear whether the university is considering disciplinary action. It’s been pretty chaotic, but we’re still on.
Our university gives the impression that it provides standard care to its religiously-diverse student population, perhaps because it fears alienating its many moderate Catholic and non-Catholic students. Its insurance plans technically cover birth control because it is ineligible for the religious exemption in New York’s Women’s Health and Wellness Act, but still make access to birth control difficult and expensive and in this way it really isn’t “covered.” So even at a university that does not qualify as a religious institution under state law, women’s health is quietly marginalized for religious reasons.
This is not something anyone, let alone a bunch of soon-to-be lawyers, should just accept. We deserve documentation of the policies affecting our health and finances and the freedom to solve the problems they cause off-campus at the very least. The law school student body and faculty have been extremely supportive; they are grateful and proud of our efforts. Students have shared their stories with us of how the university’s practices have affected their lives and health and an important conversation has begun on campus. And, the university seems to be taking our concerns a bit more seriously since we decided to take matters into our own hands.
These groups are asking you to join them in telling the White House not to capitulate to the United States Conference of Catholic Bishops and throw women under the bus on contraceptive coverage: