Health Care Reform Targets Women’s Preventive Care: HHS Announces New Coverage Requirements

The Obama Administration, through the Patient Protection and Affordable Care Act (PPACA), has initiated another move in its ongoing efforts to improve the nation’s health care system. On August 1, the U.S. Department of Health and Human Services (HHS) announced in a statement that less than a year from now, insurance companies will have to cover several women’s preventive services without requiring co-pays, co-insurance and deductibles. The rules apply to insurance policies with plan years beginning on or after August 1, 2012. 

Services insurance companies must cover without “cost-sharing” include:

• well-woman visits;
• screening for gestational diabetes;
• human papillomavirus (HPV) DNA testing for women 30 years and older;
• sexually-transmitted infection counseling;
• human immunodeficiency virus (HIV) screening and counseling;
• FDA-approved contraception methods and contraceptive counseling;
• breastfeeding support, supplies, and counseling; and
• domestic violence screening and counseling.

While the rules are one of the most wide-reaching and potentially popular provisions of the health care law adopted last year, according to The Washington Post, the new rules are also drawing some criticism.  The federal government predicts insurance premiums will rise as a result of the new guidelines, but an estimate has not been released. CBS’ online newsletter states, “The cost will be spread among other people with health insurance, resulting in slightly higher premiums. That may be offset to some degree with savings from diseases prevented, or pregnancies that are planned to minimize any potential ill effects to the mother and baby.”

A San Francisco Chronicle story says conservatives criticize the plan, claiming “the White House may be engaged in an expensive boondoggle in its attempts to appeal to women voters, while businesses worried that added costs could raise insurance premiums and harm small businesses.”

Whether they are liked or not, the new rules are here…and they are dramatic, hard-hitting, and touted by HHS as a vital tool to expanding health care coverage to more Americans.

HHS’ Viewpoint

 “The Affordable Care Act helps stop health problems before they start,” said HHS Secretary Kathleen Sebelius in the HHS statement. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need.”

HHS claims that cost has held back Americans from seeking preventative care to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs. Specifically, HHS predicts that prior to health care reform, Americans used preventive services at about half the recommended rate.

This action follows the launch of new insurance market rules under PPACA that require all new private health plans to cover several evidence-based preventive services including mammograms, colonoscopies, blood pressure checks, and childhood immunizations without charging a co-payment, deductible or co-insurance. PPACA also made recommended preventive services free for people on Medicare.

One thing working in favor of the insurance companies is the fact that plans will retain the flexibility to control costs and promote efficient delivery of care, according to HHS. For example, an insurance company may charge a client if they choose a branded drug when a generic is available. 

Another caveat is an amendment that allows religious institutions that offer insurance to their employees the choice of contraception coverage. This regulation is modeled on the most common accommodation for churches available in the majority of the 28 states that already require insurance companies to cover contraception. HHS welcomes comment on this policy; concerned parties may send their comments to womensguidelines [at] hrsa [dot] gov.

The independent Institute of Medicine was charged by HHS to conduct a scientific review of preventative services and provide recommendations on specific measures that meet women’s health needs. HHS’ Health Resources and Services Administration (HRSA) used the IOM report to develop the new guidelines. The IOM’s report relied on independent physicians, nurses, scientists, and other experts to make these determinations based on scientific evidence.

For more information on the HHS guidelines for expanding women’s preventive services, visit http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html. The guidelines can be found at www.hrsa.gov/womensguidelines/. 

BenefitMall will continue to keep you apprised of the latest developments as health care reform continues to evolve.  For blog posts, legislative alerts, pools, surveys and other resources, visit www.HealthcareExchange.com.