Health and women's advocates are praising the Institute of Medicine (IOM)'s recent recommendations to include prescription birth control among the preventive health services that insurance companies must cover without a co-pay under the Affordable Care Act. This is important because cost can be a significant barrier to the consistent, effective use of birth control. For decades, birth control has been excluded from many health plans, but even when it is covered, cost-sharing keeps some women from getting it or using it consistently. A 2010 survey reveals that more than a third of women voters struggle with the cost of birth control, and the IOM report notes that women are consistently more likely than men to delay or forego health care because of cost.

The consequences of cost-related barriers to birth control are signficant: According to the Guttmacher Institute, women who do not use contraceptives or use them inconsistently account for 95% of the three million unintended pregnancies that occur every year. Unintended pregnancies can have harmful physical and emotional health effects for women, especially those who sufffer from chronic medical conditions or are at risk for health complications resulting from pregnancy. The IOM's recommendation to provide birth control as part of preventive health services is an important step toward improving the health and well-being for insured women.

As we celebrate this achievement, however, we must remember that for many women the fight for reproductive and sexual health care continues. Even with private insurance expansion under the Affordable Care Act, many women will be uninsured or covered by Medicaid. Currently, the uninsured and many Medicaid beneficiaries rely on clinics that provide free or low-cost reproductive health care, including birth control, and these clinics depend heavily on federal and state funding. Cuts in funding for family planning services, and the more radical defunding attacks that target providers of free and low-cost birth control are threatening reproductive health access and the well-being of our most vulnerable women.

Continue reading "Birth Control Coverage is a Critical Win for Women's Health, but the Fight Continues for Medicaid Beneficiaries & the Uninsured" »

Most people are aware of the problem of bad faith denials by insurance companies, but there is another troubling practice that has not received enough attention: illegal rescissions. Illegal rescissions are cancellation of coverage sold in the individual insurance market by plans that want to avoid paying for expensive medical treatment. This problem is even more serious than bad faith denials because the consequences are far worse, plans have an even greater financial incentive to do it, and it is much more difficult to prevent.

For all of these reasons, government regulators have a critical role to play in protecting consumers from illegal rescissions, yet their response has largely been slow and ineffective. One regulator in California has finally taken steps to address this problem proactively. Last month, the Department of Insurance issued new regulations designed to combat illegal rescissions. These new rules are a good start, but unfortunately do not go far enough and leave too many consumers unprotected.

Continue reading "California's Anti-Rescission Rules are a Good Start" »

In a recent post titled "California May Get Jump on Feds with Prior Approval of Health Insurance Rates," Frederick Pilot discusses legislation approved by the California state Assembly last week that would require prior approval of insurance premiums for managed care service plans and traditional indemnity insurance policies. For more information on health insurance reform, go to the Health Insurance Crisis Blog.

One of the new federal health reform protections scheduled to take effect later this year is expanded insurance coverage for young adults. As of Sept. 23, 2010, if your child is under 26 and unmarried, insurance plans must give you the option of adding insurance coverage for your child. Because this requirement does not technically go into effect until later this year, in many states children graduating from college or about to age out of their parents' plan could lose their coverage for a few months. The good news is that HHS has been working with insurance companies to close this gap, and several insurers have agreed to maintain coverage for these students. HHS Secretary Kathleen Sebelius has just issued two press releases announcing which insurers have agreed to do this and she is trying to get commitments from more. So far, Blue Cross Blue Shield, Kaiser Permanente, Humana, WellPoint, and United Healthcare are among the plans offering to continue coverage. Unfortunately, this does not appear to help young adults who have already lost coverage. They will have to wait until the law goes into effect in September.

Continue reading "Good News for Parents: Insurers Agree to Earlier Coverage Date for Some Young Adults up to Age 26" »

The Obama administration took an important step toward implementing insurance rate regulation on Monday, April 12. The U.S. Department of Health and Human Services (HHS) is requesting information that will help it effectively regulate medical loss ratios and health premium increases under the new reform legislation. Medical loss ratio refers to the proportion of premium revenues spent on clinical services and quality improvement, as opposed to profits, bonuses, and other overhead expenses.

Continue reading "First Step Toward Implementing Insurance Rate Regulation" »

Two weeks ago, the Massachusetts insurance commissioner rejected proposed rate hikes by several health insurance companies. The companies want to raise premiums an average of 8%-32% on small group and individual insurance policies, and additional costs may bring the increases up to as much as 40% in some cases, according to an article in the Boston Globe. Insurers were likely shocked because this was the first time that Massachusetts has used its regulatory power to deny rate hikes. Insurers have an opportunity to appeal the decision through the state administrative appeals process, which they are doing, but they also filed a lawsuit last week seeking more immediate relief. Insurers asked a court to allow the rate hikes to take effect pending legal resolution of the dispute, but yesterday the court rejected the insurers' request.

Continue reading "State Wins First Round in Legal Battle over Insurance Rates in Massachusetts" »

One of the most important pieces of the new health reform legislation is the expansion of private insurance. Congress tries to accomplish this by doing three things:

(1) Creating health insurance exchanges that will serve as a centralized place for regulating, standardizing, and purchasing insurance.

(2) Creating shared responsibility by individuals, employers, and the government. Employers with more than 50 employees that do not provide insurance will have to pay a fee that will be used to fund the insurance provided through exchanges. Individuals will be required to purchase insurance if it satisfies certain requirements, but will pay a tax penalty if they choose not to buy it. And to help people buy insurance, the government will provide tax credits to small employers and subsidies to individuals who make between 100%-400% of the federal poverty level (for 2009, the poverty level is $18,310 for a family of three).

(3) Creating new consumer protections and regulation of insurance to ensure that plans are affordable, provide a minimum level of benefits that are meaningful, and to prohibit plans from refusing to cover people who may seem high risk (guaranteed issue and nondiscrimination protections).

I recommend visiting the Kaiser Family Foundation website for a nice overview of the health reform legislation.

Continue reading "Regulation of Insurance Rates Key to Reform Success" »