N.Y.’s Schneiderman Proposes Expanded Free Birth-Control

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Insurers would be required to increase free access to contraceptives in New York under expanded-coverage requirements proposed by state Attorney General Eric Schneiderman as federal officials seek to clarify rules for insurance companies.

A Schneiderman-backed bill introduced Monday in the state Legislature would mandate the expansion and steeper hurdles for denying benefits or passing along costs to consumers. The measure would require that insurers cover all federally approved birth-control methods, including those used by men, and would prohibit a review process used by some companies to deny or delay coverage.

The proposal follows reports by health-advocacy groups that some insurers may have denied or passed on costs for some forms of birth control, such as intrauterine devices, hormonal patches and vaginal rings, in violation of the federal Patient Protection and Affordable Care Act of 2010.

“New Yorkers should not be penalized by their insurance companies for using the birth control method that they and their medical provider agree is most appropriate for them,” Schneiderman said in a statement. “Ensuring comprehensive, cost-free access to birth control is critical to fulfilling the goals of the Affordable Care Act and to upholding every woman’s right to contraception.”

Federal Guidance

Federal health, labor and Treasury officials on Monday issued guidance to insurance companies saying contraception and certain preventative services such as well-woman visits should be covered without imposing out-of-pocket expenses on policyholders such as a co-pay or deductible.

The officials clarified that the no-cost-sharing rule also applies to screening of at-risk women for BRCA-1 or BRCA-2 genetic mutations associated with higher likelihood of developing breast or ovarian cancer.

Actress Angelina Jolie announced in 2013 that she underwent a preventative double mastectomy after learning she carried one of the mutations, bringing attention to that cancer risk criteria.

The federal law requires most insurers to cover contraceptives for women without cost-sharing in most cases. Health plans are allowed to make patients pay some of the cost of brand-name drugs if generic versions are available. Birth control methods for men -- condoms and vasectomies -- aren’t included under the federal requirements.

Senate Opposition

The New York bill may face resistance in the Republican-controlled Senate, which has been reluctant to support measures related to the Affordable Care Act.

In 2012, Democratic Governor Andrew Cuomo resorted to an executive order to create a health exchange under the federal law after Senate Republicans blocked a bill for almost a year. The Republicans said at the time that allowing the exchange would have condoned the president’s law.

In reports published last month, the Washington-based National Women’s Law Center and Menlo Park, California-based Kaiser Family Foundation found that some insurers were charging co-payments for birth control, denying coverage or restricting benefits. Some may be violating federal rules, according to the reports.

The Kaiser Family Foundation found that some insurers limit coverage of vaginal rings, because they use the same chemical compounds as oral contraceptives, for instance.

Cost Savings

Some health plans require women to try less-costly contraceptives, such as pills, before progressing to other methods.

Of the 20 plans surveyed by Kaiser, 19 paid for generic emergency contraceptives with no limitations. Eleven covered without restrictions the so-called Ella pill, an emergency contraceptive, without imposing restrictions.

Ella can prevent pregnancy for as long as five days after unprotected sex, two days longer than other such pills, according to Kaiser.

The National Women’s Law Center said it analyzed plans offered by more than 100 insurers during 2014 and 2015 and found that more than half of the companies were violating the Affordable Care Act.

Schneiderman sent letters last week to 11 health insurers including Cigna Corp., Excellus BlueCross BlueShield, Empire BlueCross BlueShield and EmblemHealth asking whether they violate federal requirements.

Connecticut, California

Other states have taken actions previously aimed at making sure birth control is provided cost-free to policyholders. In 2014, Connecticut regulators issued a bulletin clarifying prohibitions against cost-sharing for certain services. California Governor Jerry Brown that year signed a law, which like the New York bill expanded coverage requirements. The bill didn’t include birth control methods for men.

New York’s Comprehensive Contraception Coverage Act of 2015 would codify the federal requirements and bring birth control methods for men “in line with the benefits enjoyed by women,” according to Schneiderman. The bill would also allow consumers to obtain larger amounts of contraceptives at one time than currently allowed under the federal law, according to Schneiderman, a Democrat. Obtaining free condoms under the New York bill would require a prescription.

“This legislation takes critical steps toward breaking down these barriers and providing comprehensive contraceptive coverage for all New Yorkers,” New York Civil Liberties Union Executive Director Donna Lieberman said in a statement.