Even though Obamacare requires insurers to cover a wide range of gender-specific health services — like maternity care, breast pumps, and contraception — some insurance companies still aren’t following through in this area, according to two new reports released on Wednesday by the National Women’s Law Center (NWLC).
NWLC staffers reviewed more than 100 insurance companies operating in 15 states and found violations among more than half of the insurers surveyed. Researchers documented policies that exclude maternity care for dependent enrollees, fail to cover the full range of birth control methods, limit coverage for breastfeeding assistance, charge illegal co-pays for preventative health services, and exclude coverage for services related to trans individuals’ gender transition, among other issues.
The organization concluded that, although their report only investigated 15 states, the extent of the documented issues suggests that these problems are likely to be systemic across the country.
In a statement accompanying the group’s findings, NWLC’s vice president for health and reproductive rights, Gretchen Borchelt, said that insurers are “breaking the law by denying women coverage to which they are entitled” — which threatens to undermine the significant improvements that the Affordable Care Act has made toward expanding access to women’s health services.
“Insurance companies must comply with the law, and regulators should do a better job enforcing it,” Borchelt said. “Otherwise, women will again be at the mercy of insurers whose previous discriminatory practices drove the need for reform in the first place.”
Before Obamacare took effect, women routinely paid more for their health services than men did. That was partly because insurers relied on “gender rating,” the practice of charging women higher premiums because some of their gender-specific care — like maternity coverage — makes them more expensive enrollees. It was also partly because women paid co-pays for health services related to their reproductive care, like regular doctor’s appointments for Pap smears and birth control, that their male counterparts don’t have to worry about.
The Affordable Care Act sought to level the playing field by putting an end to both of those practices. Now, there are a wide range of services that insurers are required to fully cover, without asking their female enrollees to pay any additional co-pays. And it’s illegal to charge someone more for their insurance plan because of their gender.
But the implementation of those new policies hasn’t been perfect. Previous analyses have reported that insurance companies are still making women pay more for their plans, and some insurers continue to charge women co-pays for their birth control. One of the problems is that American women themselves aren’t fully educated about their rights under the law, and may not realize that they can challenge their insurer for violating Obamacare’s provisions. (A general rule of thumb, according to women’s health advocates: If you’re charged more than $0 for birth control at the pharmacy, it’s worth doing a little bit of digging to try to figure out whether it’s an illegal charge.)
NWLC’s new report suggests that there’s an information gap among insurers, too. Some insurance companies are confused about what’s required of them under the ACA, and there isn’t enough oversight in this area to ensure they’re facing consequences that could end up helping them learn their lesson.
“It’s unacceptable that women are still being denied insurance coverage for birth control, well-woman visits, and pregnancy-related care. This violates federal law and we call on the Obama administration to take immediate steps to ensure these women get the health care they need and deserve,” Cecile Richards, the president of Planned Parenthood, said in a statement.
There has been some other recent evidence that insurance companies are attempting to skirt Obamacare’s requirements and avoid covering certain patients whose care may end up being more costly for them. Although the ACA forbids insurers from discriminating against people with pre-existing health conditions, some insurers have found a way around that — for example, by making HIV drugs too expensive for patients to afford, or by forming narrow networks that discourage chronically ill people from enrolling because they’ll be cut off from the specialists they currently see.
A spokesperson for the U.S. Department Health and Human Services told the Wall Street Journal that the government takes NWLC’s allegations “very seriously” and “will continue to provide guidance to help ensure that women have access to recommended preventive benefits and will explore whether additional measures are necessary.”