The Biden administration reminded insurers of their obligations under the Affordable Care Act.
As the GOP wages an all-out war against reproductive health rights, the Biden administration is taking steps to protect access to birth control and abortion. Most recently, the administration is pushing insurers to abide by the Affordable Care Act's birth control mandate.
The ACA requires insurers to cover 18 types of contraceptive methods without any cost-sharing, like a co-payment or deductible. The Guttmacher Institute, which tracks reproductive health legislation, explains that insurers can require "restrictions within a method category (e.g., to encourage patients to choose one hormonal IUD over another), but they may not favor one type of method over another (e.g., oral contraceptives over contraceptive rings)." It appears, however, that insurers have not necessarily adhered to this requirement.
Several Democratic members of Congress — namely the chairs of the House committees on energy and commerce, ways and means, education and labor, and oversight and reform — first raised this issue in October 2021. In a letter to Health and Human Services Secretary Xavier Becerra, Labor Secretary Martin Walsh, and Treasury Secretary Janet Yellen, the representatives informed the administration they had received reports of insurers denying birth control coverage in multiple ways, including insurers requiring people to try various forms of contraceptives before receiving coverage for their preferred method and refusing coverage for brand-name contraceptives when there was no generic option available.
In December, Democratic Sens. Patty Murray of Washington and Ron Wyden of Oregon provided additional information. Murray and Wyden told HHS that patients were required to show they had failed with as many as five different types of birth control before the insurer would cover the birth control method they desired.
The administration has responded by issuing an FAQ to insurers reminding them of their obligations under the ACA, telling insurers that the complaints are being actively investigated and that enforcement or other corrective actions could be taken. Looking forward, the administration says it is also considering whether to make changes to existing regulations to ensure complete coverage, such as making sure the FDA Birth Control Guide includes all contraceptive products approved by the FDA since previous guidelines were issued in 2019.
This guidance is in keeping with past commitments the administration has made toward ensuring full access to reproductive health services.
In ending the Title X gag rule, the administration restored capacity to the network of providers who provide low- and no-cost birth control. Many providers had left the Title X network after the Trump administration imposed a rule that required providers in the program to physically separate abortion services from other health care and stop providing any counseling related to abortion.
In September, the Biden administration sued the state of Texas over its recently enacted law imposing a ban on abortion after what amounts to six weeks' gestation, though the U.S. Supreme Court ultimately ruled the administration didn't have legal standing to sue over the law. The administration also pledged to increase access to emergency contraception in the state.
Under President Joe Biden, the FDA eliminated the in-person dispensing requirement for medication abortion drugs. Under President Donald Trump, people were required to pick up the medication in person — even during the pandemic.
All of these actions show a commitment on the part of the Biden administration to strengthening reproductive health care in the United States. As the GOP continues to wage war on abortion rights in the courts and in state legislatures, advocates say such a commitment is ever more necessary.
Published with permission of The American Independent Foundation.