Contraceptive Coverage Under the ACA: Clinics, Claims, and Counterpoints

Before beginning my internship at the Network, I worked at a reproductive health clinic in Minneapolis, Minnesota. The clinic offered a myriad of services ranging from annual pap smears to abortion care to contraceptive management.  You might think that when it came to fighting with insurance companies, our biggest point of contention would be coverage for abortion services. But no, the daily debates surrounded an even more basic kind of care: contraceptives.  Perhaps this is not all that surprising  given today’s political climate that has made uttering the word ‘vagina’ in the Capitol building akin to shouting ‘Voldemort’ in the middle of the Ministry of Magic.

Every patient that came into the clinic for contraceptive care necessitated a phone call to their insurance company—did they cover the type of hormonal birth control that the patient and doctor had agreed was best? Did their policy cover the cost of the device AND its insertion?  These tedious and time consuming phone calls continued even after the passage of the Affordable Care Act in 2010. The ACA was supposed to obliterate the denial of coverage based on such technicalities by mandating complete contraceptive coverage at no additional cost to the insured.

Yet swaths of women are still not getting the coverage that the law intended. Insurance companies are exploiting vague language in the law to deny women access to birth control.

Thankfully, the Kaiser Family Foundation has stepped in to provide much needed research on this topic. And I had the privilege to attend today’s briefing in which they released their new report that examines the impact of insurance companies’ interpretation of the ACA’s contraceptive coverage provision.

Surprisingly, the take-away is not terrible! Many of the insurance companies included in the study covered most kinds of contraception. But importantly, few covered ALL.

Insurance companies that are covering some but not all kinds of hormonal contraception—for example the pill but not the patch—or are covering the generic but not the brand even in cases where there is no generic equivalent are not simply creating barriers to access for patients and hassle for practitioners but as Gretchen Borchelt of the National Women’s Law Center pointed out, they are violating the law.

The Kaiser Family Foundation has provided the source material that will fuel the advocacy work that the Network will carry forward. State and national regulatory agencies need to step up to ensure that insurance companies are not indefensibly expanding the scope of their authority in order to deny women what they are entitled to under the law.

Check out Kaiser’s full report here:

Zoe Krusintiz was a NWHN Intern in Spring 2015.

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