On Wednesday the Affordable Care Act will require insurance companies to cover eight new preventive health services for women, with no copays. These provisions supplement a series of preventive care requirements already instituted when the ACA passed two years ago. And while some states already require insurance plans to cover some preventive services, these requirements will be new for insurance providers in New Hampshire.
The female-specific services are based on guidelines recommended by the independent Institute of Medicine, at the request of Health and Human Services. Here’s what’s covered:
- Annual “well-woman” visits for general preventive health
- High risk HPV DNA testing
- HIV screening and counseling
- Various methods of birth control
- Screening and counseling for domestic violence
- Counseling on Sexually Transmitted Infections
- Screening for gestational diabetes
- Breastfeeding supplies and counseling
These are all in addition to the mammograms, cervical cancer screenings, prenatal care and other services already covered and copay-free under the Affordable Care Act.
The most controversial provision, of course, is mandated coverage of contraception. This spring, New Hampshire’s House of Representatives attempted to pass a bill exempting religious organizations from the mandate, and later tried to attach a similar provision onto an unrelated Senate bill. Both attempts failed.
Nevertheless, the White House has offered exemptions to churches, synagogues, and other houses of worship. Other religious nonprofits have a one-year grace period, after which they must offer employees access to contraception directly from the insurance provider.Usha Ranji of the Kaiser Family Foundation says the array of women-only services is necessary because women use healthcare differently than men. Not only do women have more healthcare needs associated with childbearing, but women are also more likely to delay receiving health care because of costs. Ranji says this may be due, in part, to the fact that women have lower incomes than men, and have been charged higher premiums in the independent market.
According to the Kaiser Foundation’s Focus on Health Reform report, the effect of copay-free preventive services on insurance premiums is likely to differ for each state. Tyler Brannen of New Hampshire’s Insurance Department says “it just goes back to the endless debate. If you pay for it ahead of time, will the overall costs come down?” Either way, Brannen says, preventive care is one of the least costly aspects of the ACA. If anything, he says, it is fertility, autism, and prescription drug coverage – not preventive services – that may drive up costs. Despite the imprecision of such estimates, HHS has calculated that premiums may increase 1.5 percent due to the ACA’s preventive care requirements.