In the letter, Feinstein and her colleagues urged Secretary Burwell to help states develop plans of action to ensure health plans comply with the Affordable Care Act, provide full access to all FDA-approved form of contraception, and take appropriate enforcement action when necessary.“In the 21st century, women should have access to affordable, comprehensive healthcare services, like birth control, that empower them to make their own healthcare decisions and provide economic security for their families. By helping women get contraceptive coverage and other essential health benefits without cost-sharing, the Affordable Care Act took a critical step toward this goal,” the Senators wrote.“Unfortunately, we write with serious concerns that some insurers are failing to uphold the standards set in the Affordable Care Act and as a result leaving women without the health care services they are entitled to under the law.”
The Affordable Care Act provided access to important preventive services, including birth control, at no cost. However, recent reports by the National Women’s Law Center, the Kaiser Family Foundation, and the Northwest Health Law Advocates and NARAL Pro-Choice Washington indicate that some qualified health plans are not in compliance with the law, and have been denying women coverage, charging them incorrectly, or providing inaccurate information.
Last week, Murray sent a letter to eight insurers in Washington state calling their failure to provide accurate information unacceptable, and encouraged them to be proactive and increase transparency. Already two of those insurers, Coordinated Care and Bridgespan, have responded in writing, and proactively committed to improving and addressing issues reported.
The following Senators cosigned the letter to Secretary Burwell: Senators Patty Murray (Wash.), Barbara Boxer (D-Calif.), Harry Reid (D-Nev.), Chuck Schumer (D-N.Y.), Sherrod Brown (D-Ohio), Mazie Hirono (D-Hawaii), Dick Durbin (D-Ill.), Claire McCaskill (D-Mo.), Tammy Baldwin (D-Wisc.), Barbara Mikulski (D-Md.), Debbie Stabenow (D-Mich.), Tim Kaine (D-Va.), Patrick Leahy (D-Vt.), Elizabeth Warren (D-Mass.), Richard Blumenthal (D-Conn.), Al Franken (D-Minn.), Jeanne Shaheen (D-N.H.), Kirsten Gillibrand (D-N.Y.), Ed Markey (D-Mass.), Chris Coons (D-Del.), Michael Bennet (D-Colo.), Amy Klobuchar (D-Minn.), Bernie Sanders (I-Vt.), Maria Cantwell (D-Wash.), Sheldon Whitehouse (D-R.I.), Martin Heinrich (D-N.M.), Ben Cardin (D-Md.), Bob Menendez (D-N.J.), Cory Booker (D-N.J.), Gary Peters (D-Mich.), Jeff Merkley (D-Ore.), Ron Wyden (D-Ore.), Chris Murphy (D-Conn.), Tom Udall (D-N.M.), Brian Schatz (D-Hawaii), Jack Reed (D-R.I.), Jon Tester (D-Mont.), and Mark Warner (D-Va.).
Full text of the letter to Secretary Burwell:
Dear Secretary Burwell:
In the 21st century, women should have access to affordable, comprehensive health care services, like birth control, that empower them to make their own health care decisions and provide economic security for their families. By helping women get contraceptive coverage and other essential health benefits without cost-sharing, the Affordable Care Act (ACA) took a critical step toward this goal, and nearly 50 million women are benefiting today. Unfortunately, we write with serious concerns that some insurers are failing to uphold the standards set in the Affordable Care Act and, as a result, are leaving women without the health care services they are entitled to under the law.
From 2012 to 2013, as a result of progress made in the ACA, the number of women who filled their prescriptions for oral contraceptives without a co-pay nearly quadrupled from 1.3 million to 5.1 million, and in 2013 alone, women saved more than $483 million in out-of-pocket costs for birth control. We appreciate the Department’s work to implement this provision.
Recently, however, there have been ongoing reports of health insurance carriers and pharmacies failing to provide these benefits or provide accurate information about their availability, in clear violation of law. Two reports by the National Women’s Law Center based on national surveys, the State of Birth Control Coverage, and State of Women’s Coverage, document such failures, and the Kaiser Family Foundation’s “Coverage of Contraceptive Services” report shows a general lack of consumer awareness of the no-cost contraception benefit and non-compliance.
The Northwest Health Law Advocates and NARAL Pro-Choice Washington also recently released a report, Contraception Coverage in Washington’s State Qualified Health Plans, which similarly showed health plans on Washington Health Benefit Exchange are out of compliance with the law. The report found that carriers—specifically customer service representatives—did not seem aware of the requirement to provide birth control at no out-of-pocket cost to consumers and were providing consumers with incorrect information. The report also found that some insurance carriers’ formularies categorized certain forms of contraception like IUDs, which have been shown to be 99.9% effective in reducing unintended pregnancies, on higher priced drug tiers or excluded them entirely.
These reports document a troubling nationwide trend. Research shows that costs can significantly restrict women’s ability to get the right care. In fact, almost one third of women report they would change their form of contraception if cost were not a factor. This is why the ACA provided for access to all FDA-approved forms of contraception, and why it is critical that we ensure women get the full range of health care services that insurers are now required to cover.
The Department of Health and Human Services should be closely monitoring and ensuring compliance with the law, and working with all stakeholders to reach that end.
Specifically, we request that you:
• provide greater clarity on the ACA requirement to cover all FDA-approved forms of contraception for carriers and take appropriate enforcement actions;
• increase consumer education and awareness of the benefits of the ACA, including contraception; and
• proactively encourage states to properly enforce compliance, and ensure that local stakeholders and states develop plans of action for compliance.
We applaud the steps that the Department has already taken to provide clarity regarding oral contraceptives, but clearly more must be done to ensure that women are receiving the full range of contraceptive benefits guaranteed by law. We ask that you provide us a written update on your actions to ensure they do. We look forward to continuing to work together to ensure all women have access to all methods of FDA-approved contraception.
Sincerely,
