Democrats Urge Insurers to Cover Birth Control Per ACA Requirements

Despite the contraception coverage requirement in the Affordable Care Act (ACA), noncompliance by insurers is forcing women to pay out of pocket or face hurdles to accessing birth control, according to the Democratic Women’s Caucus.

More than 150 House and Senate Democrats wrote a letter addressed to Mike Tuffin, president and CEO of AHIP, the political advocacy and trade association of health insurance companies, expressing their concerns that health insurers are not complying with the contraception coverage requirement and urging them to adopt a “therapeutic equivalence standard” of FDA-approved birth control products that have no generic option.

In a media briefing call, Representative Judy Chu of California’s 28th district led a discussion on the importance of removing the red tape preventing access to birth control. She was joined by Representative Jennifer McClellan, of Virginia’s 4th district; Gretchen Borchelt, vice president of reproductive rights and health at the National Women’s Law Center; and Rachel Fey, vice president of policy and strategic partnerships at Power to Decide.

Representative Judy Chu of California’s 28th district

“…as reproductive rights are attacked by extremist courts and politicians all across the country, ensuring that women have access to the form of birth control that is right for them is more important than ever,” Chu said.

Recent guidance released by the Biden administration outlines a standard for requiring coverage of every FDA-approved contraceptive without a generic without cost-sharing. Previous guidance had required at least 1 form of each contraceptive method be covered without cost-sharing, the caucus noted in its letter to Tuffin. According to the new guidance, if there is a therapeutic equivalent, the plan may choose to cover only 1 product as long as the plan “maintains an acceptable exceptions process in the case that a patient needs a specific product,” the caucus wrote.

Since 2010, patients have repeatedly reported issues with accessing birth control they need, Chu said. Allowing patients access to their contraceptive of choice is critical because what works for one person could have severe or debilitating adverse effects for another, she said. However, patients are still reporting that they may be required to use one method of birth control before being offered an alternative.

Representative Jennifer McClellan of Virginia’s 4th district

There may be a wide variety of reasons for someone to use birth control, including health care reasons beyond preventing pregnancy. McClellan related her own personal story of how she needed contraception to treat ovarian cysts while in her 20s. Then after giving birth in her 40s, her doctor recommended she have an intrauterine device to avoid the risk of negative adverse effects from a hormonal pill at her age.

“That was a decision I made in consultation with my doctor,” she said. “The idea that my insurance company could deny me access to the specific contraception that we believe is best for me, blows my mind and frankly infuriates me.”

The ACA mandate is not a suggestion, McClellan added, but is a requirement of law. And despite the ACA being the law of the land for over a decade, the National Women’s Law Center still gets complaints through its hotline from patients who are being forced to pay out of pocket or whose insurance companies are giving flat out denials or providing misinformation about the law’s requirements, Borchelt said.

“No one should be left out of the incredible benefits that this coverage brings,” she said. In addition to saving women and families billions of dollars in out-of-pocket costs and increasing adherence to contraception, there are “payoffs in terms of education opportunity and career advancement and financial stability. We're seeing it now and we're going to continue to see that for decades because it improves people's health and well-being, it helps people to be more financially secure, it advances gender equality, and it's helping people plan and space pregnancies…”

The guidance from the Biden administration offers an easy way for plans to be in compliance with the ACA contraceptive coverage provision, explained Fey. However, Power to Decide urges the administration to couple the new guidance with enforcement. When insurers fail to comply with the mandate, it perpetuates an equity gap between the patients who can pay for the full cost and those who cannot, those with the resources to go back and forth with the insurance plan and those who without.

“…it's time for plans themselves to respond and demonstrate that they are following the ACA and covering the contraception that their beneficiaries who pay their premiums are entitled to receive without additional costs,” Fey said.