The Obama administration took action last month to shift responsibility from employers to insurance companies.
The "accommodation" generated fierce opposition from religious groups, as well as health reform critics, leaving insurers anxious about the details. They will have to contact individual beneficiaries directly, explaining how to obtain free contraceptive services outside their plans-including birth control therapies, Plan B and sterilization services.
Although insurers routinely offer contraceptive coverage as part of comprehensive benefits, America's Health Insurance Plans (AHIP) raised concern about "the precedent this proposed rule would set." Government requirements that plans provide benefits with no copays and no adjustment in premiums can only add costs for insurers. Oral contraceptives can cost $600 a year, according to Planned Parenthood, and experts acknowledge the financing has to come from somewhere.
The controversy escalated in January when the administration announced only minor changes in its requirement that all insurance plans must cover contraception as part of free preventive services mandated by the Patient Protection and Affordable Care Act of 2010 (PPACA). The rule, which was initially proposed in August 2011, exempted churches and other houses of worship. But the administration clarified that the exemption would not apply to religious-affiliated organizations, such as hospitals, universities and non-profits. The organizations have an extra year to comply, a proposal that raised a firestorm of protest. Republicans in Congress and presidential contenders accused the White House of trampling on religious freedom.
In presenting the new policy, the administration noted that 28 states already require some coverage of birth control, most with an exemption for religious employers. Hawaii and several states require insurers to cover contraception for employees at religious organizations that choose not to offer that benefit. But these states expect the employer to notify workers how to obtain contraception coverage, and few require first-dollar coverage, as the federal policy requires.
FINALIZING POLICY RULES
The administration faces a hard task in developing regulations for implementing the new policy during this year's transition period. One big question is how religious-affiliated employers that self-insure will deal with the new policy. In such cases, the insurers primarily process claims, and the employer thus would be responsible for providing birth control services. Many religiously-affiliated employers offer birth control coverage to meet state requirements, but, ironically, some large organizations have switched to self-insurance in recent years to avoid state mandates.
The Catholic Health Assn. expressed support for the revised policy, as did women's health groups and civil liberties advocates. But the U.S. Conference of Catholic Bishops rejected the compromise as unworkable and unethical, and insisted that contraception still would be financed by employers as part of overall healthcare coverage. Republicans blasted the requirement as "a fig leaf" and one more reason why Congress needs to repeal the Obama healthcare law entirely.