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Health Care Reform: WLP Policy Advocacy

WLP is committed to improving access to comprehensive, quality, and affordable health care for women. To that end, WLP is working to ensure that women obtain essential health care benefits and that discrimination in benefits and pricing is eliminated.  WLP is advocating on both the federal and state level for comprehensive health care for women, including contraceptive coverage and maternity coverage (prenatal, delivery, and post-partum).

Preventive Services

On August 11, 2011, pursuant to the requirement of the Affordable Care Act to develop a list of covered preventive health services for women, the U.S. Department of Health and Human Services (HHS) issued guidelines requiring all new health insurance plans to cover a range of preventive services with no copayments, cost sharing, or deductible  beginning August 1, 2012.  The guidelines are available at http://www.hrsa.gov/womensguidelines/.

The services covered by these guidelines 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, breastfeeding support, supplies, and counseling; domestic violence screening and counseling, and all FDA-approved contraception methods and contraceptive counseling.

Following its issuance of proposed regulations providing an exemption for religious institutions from the contraceptive coverage requirement, church leaders exerted pressure on HHS to broaden the exemption.  Resisting this pressure, HHS announced on January 20, 2012 its adoption of a narrow definition limited to religious employers that exist for the purpose of inculcating religious values and that primarily employ and serve people who share the employer’s religion, and are nonprofits under federal tax laws.WLP submitted comments urging HHS to remove or narrowly limit the scope of any exemption for religious employers. See Coverage of Preventive Services Under the Patient Protection and Affordable Care Act; CMS-9992-IFC2 (September 30, 2011).

Essential Health Coverage for Women

Beginning in 2014, the Affordable Care Act will require all new insurance plans in the individual, small group, and exchange (state-sponsored marketplaces for purchase of health insurance) markets to include coverage for Essential Health Benefits, items and services within 10 benefit categories: (1)ambulatory patient services, (2) emergency services, (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services, including behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services (9) preventive and wellness services and chronic disease management, and (10) pediatric services, including oral and vision care.  Many of these services are essential to women’s health.  How the Department of Health and Human Services (HHS) defines the scope of services to be provided in these categories and how Pennsylvania implements them will be important to women.

Essential Health Benefits

  • On November 8, 2011, at a listening session held by the Department of Health and Human Services (HHS) on how HHS defines essential health benefits, Managing Attorney Terry L. Fromson commented on the need to broadly define essential benefits, focusing specifically on maternity and behavioral health benefits.  Under the ACA, all new health plans selling coverage to individuals and small groups must provide the Essential Health Benefits, which include items and services in at least 10 categories listed in the Affordable Care Act. HHS is responsible for defining the scope of coverage that must be provided in these categories and conducted listening sessions around the country to obtain input.  Fromson emphasized the importance of defining maternity and newborn benefits to include prenatal, delivery, and postpartum care, elements of insurance coverage often unavailable to women.  In response to HHS request for comment on the Institute of Medicine’s recommendations to HHS released on October 7, 2011, Fromson expressed disagreement with IOM’s recommendation that HHS take cost into account and use a small employer plan as the typical health plan benchmark to guide HHS in defining essential health benefits. See WLP comments to HHS on Essential Health Benefits, November 8, 2011 .
  • On January 31, 2012, WLP submitted comments to HHS on the Essential Health Benefits Bulletin published on December 16, 2011.  In the bulletin, HHS proposed that states define essential health benefits by selecting a benchmark plan from: any of the three largest plans by enrollment from the state’s small group market, state employee health benefit plans, or Federal health plans, or from the largest non-Medicaid HMO plan in the state.  http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits
    _bulletin.pdf    . WLP’s comments urge HHS to adopt clear minimum standards for each benefit category, in order to increase women’s access to comprehensive essential benefits.

Pennsylvania Health Care Exchanges

WLP submitted comments to the U.S. Department of Health and Human Services and the Pennsylvania Insurance Department on implementation of the insurance exchanges (marketplaces for purchase of insurance) which the Affordable Care Act requires states to implement.

Rulemaking on the Patient Protection and Affordable Care Act; Establishment of Exchanges
and Qualified Health Plans (September 26, 2011)

Written Testimony of WLP to PA Insurance Department on Implementation of Health
Insurance Exchanges (August 26, 2011)

WLP Blog Post:

Pennsylvania: Stop Insurers from Denying Essential Maternity Coverage to Women
(November 22, 2011)

 

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