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« How do we find and enroll still-uninsured people? | Main | Words of Wisdom from Byllye Avery »

Your women’s health coverage could soon be even better!

Birth control without a co-pay. Well-woman visits without a deductible. Millions of women with private health insurance have benefitted from the preventive service coverage guaranteed by the Affordable Care Act. But that coverage may soon be even better!

For example, contraceptive coverage for women could be expanded to include a vasectomy for a woman’s male partner. Another proposal would allow a woman to receive a 12-month supply of contraceptives at once, thus eliminating risky gaps in birth control that can happen when a woman is delayed getting her prescription refilled. These are just some of the recommendations undergoing review through the Women’s Preventive Service Initiative (WPSI), a process that is being used to update the list of women’s preventive services that must be covered with no cost-sharing under the Affordable Care Act (ACA).

What is this review process and how does it work?

How did we get the women’s preventive services provisions in the ACA and who decides which services must covered? It’s not a straightforward matter.

The story begins on December 3, 2009. The Senate had just started floor debate on the ACA, which would last for a near-record 25 consecutive days and culminate in the first Christmas Eve vote since 1895, when the Senate would pass the ACA by a vote of 60-39. But first, Senators Barbara Mikulski (D-MD, pictured at left) and Lisa Murkowski (R-AK) had dueling women’s health amendments on the floor to settle. The former would quip of the latter: “She’s Murkowski. I’m Mikulski. We sound alike. And the amendments might sound alike. But boy, are they different.” The tenacious Democrat would win the vote and the day, but that would just be the beginning of a multi-year process to ensure that women have access to preventive care without cost-sharing.

Mikulski’s one-page Women’s Health Amendment was deceptively simple. It affirmed the underlying bill’s coverage of preventive services like breast cancer screenings without out-of-pocket costs, while also ensuring a broad range of additional protections for women. It did this by tasking the Health Resources and Services Administration (HRSA) -- an agency of the US Department of Health and Human Services (HHS) -- to draw up a list of “additional preventive care and screenings not described” elsewhere in the bill.

HRSA turned to the then-Institute of Medicine (IOM), which developed eight guidelines to be covered in health plans starting 2012:

  • Annual well-woman visits
  • Screening for gestational diabetes
  • Human papillomavirus testing
  • Counseling for sexually transmitted infections
  • Counseling and screening for human immune-deficiency virus
  • Contraceptive methods and counseling
  • Breastfeeding support, supplies, and counseling
  • Screening and counseling for interpersonal and domestic violence
But as supporters of Raising Women’s Voices know, the story didn’t end there. The IOM’s guidelines were historic in scope, but vague on implementation details. For example, when it came to contraceptive coverage, insurance companies argued that compliance could mean covering one daily oral pill free of charge, while still requiring co-pays for all other kinds of hormonal contraceptives. Women expecting to benefit from the ACA’s guarantee instead found themselves paying out of pocket for patches, rings and more.

Mikulski’s Women’s Health Amendment envisioned contraceptive coverage, but didn’t directly enumerate it, and so the fight for contraceptive coverage has famously played out over the course of two Supreme Court battles to determine whether religiously-affiliated employers must provide coverage. But the fight has also been waged in less visible negotiations with insurance companies, advocates including RWV, members of Congress, and administration officials -- with the federal government ultimately issuing multiple rounds of guidance.

So, what’s happening now to expand coverage?

IOM recommended that its list be re-evaluated every five years to address scientific advances. For this cycle, HRSA awarded the American College of Obstetricians and Gynecologists (ACOG) a five-year grant to update the recommendations. Their process--dubbed the Women’s Preventive Services Initiative (WPSI) -- issued draft recommendations last month updating and expanding the scope of covered services, and building upon the lessons learned over the last four years.

For example, the proposed contraceptive guidelines recommend that “the full range of Food and Drug Administration (FDA)-approved contraceptive methods, effective family planning practices, and sterilization procedures be included.” Importantly, they also provide “clarification” and “implementation” recommendations that would make clear exactly what is meant by “full range” and “practices.” The recommendations provide explicit coverage for multiple visits, removal or cessation of method (such as removal of an IUD), counseling to achieve “patient-centered decision making,” and more.

For the first time ever, the recommendations also ensure coverage for over-the-counter contraceptive products without a prescription, the ability to pick up a 12-month supply at a time, the use of copper IUDs for emergency contraception, and coverage for male methods of contraception. Under current regulations, a woman can end up pushed into a more invasive tubal ligation because her partner’s vasectomy isn’t covered without cost-share. The draft recommendations wisely note that “the most appropriate choice to prevent pregnancy for a woman might include a vasectomy for her partner or use of male condoms.”

The WPSI group will send its final recommendations to HRSA on December 1, which is then expected to seek public comment. You can count on RWV to let you know when it’s time to weigh in with your comments! If approved, the new guidelines will go into effect for most health plans in 2018.

Another “Byllye-ism” from Byllye Avery

In last week’s newsletter, we shared some of the fabulous “Byllye-isms” that RWV Co-founder Byllye Avery presented at the Community Catalyst Advocates Convening in Atlanta. Our readers loved this feature! So, we are sharing another one of Byllye’s sayings this week.

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