FOR IMMEDIATE RELEASE
August 1, 2012 Contact: Christine Sinatra (512) 473-2274
Texas Women and Texans Whose Insurers Charged Too Much for Administrative Costs Last Year Have Milestones Today
AUSTIN – Important improvements in women’s preventive care and a milestone related to controlling health care spending coincided today with a Texas legislative hearing about what the Affordable Care Act means for our state. Even as lawmakers from two state senate committees heard testimony about the nation’s health reform law, 3.4 million Texas women were affected by provisions of ensuring women could receive preventive care, including screenings, check-ups and contraception, without out-of-pocket costs. Additionally, Wednesday is the deadline by which the Texas insurers who spent less than 80 percent of last year’s premiums on actual health care must distribute rebates to small businesses and policy-holders to make up the difference.
“These developments will not only protect Texans’ health, but also save them their hard-earned money,” said Mimi Garcia, Organizing Director with Texas Well and Healthy, a statewide grassroots campaign to improve health care in Texas. “These are big steps forward for women’s healthcare and for better value in health insurance premiums. They help Texans protect their health and their finances.”
Beginning today, all women’s health plans moving forward must include the preventive health care services recommended by the Institute of Medicine without co-payments, co-insurance, deductibles or other out-of-pocket costs. This includes well-woman visits, birth control, breastfeeding supports and screenings and counseling, for things ranging from gestational diabetes to domestic violence.
Today is also the deadline for health insurance companies that have to give rebates to their customers if they spent less than 80 percent of last year’s premium dollars on health care, as opposed to overhead and profits. The Affordable Care Act requires health insurance companies to follow this 80-20 rule, and those that failed to last year in Texas have been reimbursing small businesses and Texans with individual policies for the past several weeks. In 2012, over 1.5 million Texas families will have received a total of $167 million in refunds, averaging $187 per family.
For more on today’s hearing at the Texas legislature, which is being jointly held by the committee on health and human services and the committee on state affairs, visit http://www.senate.state.tx.us/.
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The Texas Well and Healthy campaign is a broad, grassroots coalition working to ensure that every Texan has access to comprehensive and affordable health insurance. It is a collaboration of members of Cover Texas Now and other health care coalitions in the state, and led by the Center for Public Policy Priorities, Children’s Defense Fund- Texas, Engage Texas and Texans Care for Children. More about the campaign is at http://texaswellandhealthy.org
Dear Cheasty,
I’m confused about the contraception regulation controversy that exploded in the news last week. I was under the impression that women already have access to birth control through their insurers. Is anything going to change with the compromise they reached on Friday?
Thanks,
Confused about Contraception
Dear Confused,
Creative Commons License photo credit: brains the head
Well, the air is still clearing, and even health policy experts still have some unanswered questions, but I can at least clarify the basic facts and circumstances for you. Let’s start by addressing your first point.
You are mostly correct in your belief that women already are guaranteed access to contraception coverage through their insurer. Just like the Obamacare mandate, for a number of years now the state of Texas has had a law in place that requires any insurance plan that offers prescription drug coverage to also cover contraception. That includes all FDA-approved methods, from the birth control pill to diaphragms, to IUDs. (Not condoms, which are sold over the counter, but you get my drift.) Texas is one of 28 states that have such regulations, but even in states without the laws, this was fairly standard practice. The innovation here is that Obamacare promises women access to contraception with no additional co-pay – in other words, free.
But what was the big deal? Hasn’t this “no co-pay contraception” part of Obamacare been in the news for a while? Why, all of the sudden, were Catholic bishops on tv and radio complaining about government interference in their right to religious freedom?
In short, that’s a great question. First of all, the Obama administration did not, as it might appear from the dust-up, just release a regulation solely about contraception coverage. What we’re talking about here are the ACA’s regulations about preventive care. Preventive care includes everything from annual exams to mammograms, blood work, colonoscopies, and yes, contraception.
Anybody who is paying attention has known about these regulations for months. But early last week, The Department of Health and Human Services released their final version of the regulations, and the Catholic bishops were ready for battle.
The original (pre-kerfuffle) regulations contained an exception for religious organizations. So if an organization’s primary purpose is the practice of religion (i.e., a church or diocese), then it doesn’t have to cover contraception through its insurance plan. However, if an organization is affiliated with a religion, but its primary purpose is not the practice of religion, (i.e., Seton Hospital or charities), then those institutions were not exempt.
The Catholic bishops were furious because, in essence, they felt the regulation was forcing Catholics to condone and pay for something that violated their religious beliefs. In an election year where conservatives seem to be grasping at straws, this generated a lot of political momentum.
Friday’s compromise quelled the hubbub by retaining the original exemption for churches, and by setting up a system that will work as follows. If Jane Doe works for XYZ Catholic University and XYZ doesn’t cover contraception, Jane Doe will call XYZ’s insurance company and say, “Hey insurance company, I need coverage for contraception.” The insurance company will then adjust Jane Doe’s policy to cover contraception. XYZ’s insurance plan will pay for it, but the cost will not come out of the plan’s premiums. This way, the employer need not know, nor must they pay.
Wait a second, you say. The insurance company will just eat the cost of contraception?
Essentially, yes. Obama wagered that insurance companies would be okay with this deal because it’s cost effective for them (birth control is way cheaper than an unintended pregnancy), and pretty much, he was right. They’ve issued a statement belly-aching about “setting a bad precedent,” but so far, so good. Churches and diocese and the like will still have the exemption they started with, but all the rest of us will have access to contraception at no additional co-pay, as originally promised in the law.
Disaster averted, it seems, for the time being. While the U.S. Bishops are still not satisfied, it appears most catholic voters support the policy.
Well, Confused about Contraception, I hope this helped clarify things for you about contraception. In short, you can rest easy. No matter where you work, or what your employer’s position on birth control is (unless you work for a Catholic church), your guaranteed access to contraception coverage is secure. It took some fancy footwork, but by Friday evening all seemed to have calmed down. What a roller coaster!
To a well and healthy Texas,
Cheasty Anderson
Center for Public Policy Priorities
