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Will Health Provisions Tame Birth Control Cost?


I'm Michel Martin, and this is TELL ME MORE, from NPR News. Later in the program, we are going to talk about that massive power outage in India that left more than half the country in the dark this week. Officials say that power has now mostly been restored. But we are going to hear from a columnist and author who says that it is actually a symptom of a much bigger problem in the country than the admittedly very large problem of such a massive power outage. We'll have that conversation in just a few minutes.

But first, we turn to some major changes in women's health and insurance that could affect you. A number of provisions of the Affordable Care Act go into effect today, including a requirement that insurance companies cover preventative services for women. Here's the Secretary of Health, Kathleen Sebelius, touting the changes at a press conference yesterday.


SECRETARY KATHLEEN SEBELIUS: For too long, insurance companies have stacked the deck against women, forcing us to pay more for coverage that didn't meet our needs. And thanks to the Affordable Care Act, a new day for women's health has finally arrived.

MARTIN: Also, men and women, you might have gotten a letter from your insurance company telling you about a refund you or your employer might be getting, and you might be wondering what that's all about. We've called Mary Agnes Carey to ask her to explain as much of this as we can. She's a senior correspondent for Kaiser Health News. That's an independent news service here in Washington, D.C. And she's been good enough to come over from time to time to talk about the health law.

Welcome back. Thanks so much for joining us once again.

MARY AGNES CAREY: Thanks for having me.

MARTIN: I do think it's important to acknowledge that a number of these provisions - not to mention the law itself - remain politically controversial. The expected Republican presidential nominee Mitt Romney is vowing to repeal these changes, but we want to set that aside for now and just talk about what is. So I want to ask you first: What are the most far-reaching provisions that go into effect today?

CAREY: Well, for plan years that renew as of today or beyond today, August 1st, there are several, as you mentioned, provisions for women. They include well-women visits, gestational diabetes screening for pregnant women, of course, coverage of contraception. That's been very controversial. The supplies and counseling for breastfeeding, HIV screening and counseling. These are among the provisions that apply to most plans that go into effect.

MARTIN: So it applies to private plans, as well as women on government-funded programs?

CAREY: Medicare has already changed in several ways to have some of these services provided. And for Medicaid, that's a shared federal-state health insurance program, lots of flexibility for states. If states provide these preventative services and don't have any cost-sharing, the federal government's going to give them a 1 percentage point increase in the amount of money they provide to states.

MARTIN: We've got a lot of questions through various means - our Facebook page and so forth - about some of those contraception provisions. So I want to play a clip of one question that we got from an NPR listener through our Facebook page, NPR listener Cindy Pash(ph) of Kansas City, Missouri.

CINDY PASH: Currently, I'm on a generic birth control pill, and I pay a $10 co-pay for that each month. So I'm wondering: Are my birth control pills going to be free?

MARTIN: What about that?

CAREY: Once her plan year renews - for example, if it starts again on September 1st or January 1st - co-pays and deductible are not to be applied to these services. So as I understand it, she should not have to pay a co-pay once her plan renews.

MARTIN: But a lot of women pay a lot more than $10 a month for these services. So whatever the cost...

CAREY: It should be - as explained by Kathleen Sebelius, who you just played on her, if the co-pays and deductibles are waived, then that should apply here.

MARTIN: We also got a lot of questions about what kind of contraception would be covered. Is there a difference, for example, between the treatment of generic and brand name?

CAREY: I would refer individuals to the plan's formulary. That's the fancy name for the list of drugs covered. Some plans might require one drug over another, or you start with a generic and if you have a problem, then you can proceed. So that's where I would look to get that information.

MARTIN: If you're just joining us, you're listening to TELL ME MORE, from NPR News. We're talking about new healthcare changes that go into effect today under the Affordable Care Act, including some related to contraception and women's health. We're dealing with questions that we've gotten from listeners. I'm joined by Mary Agnes Carey, senior correspondent at Kaiser Health News. That's an independent news service.

There's also that letter that I referred to earlier. A lot of people got this, and they're wondering: What's this about? It says that insurers have to spend at least 80 percent of their premium dollars on medical care, and those who haven't will need to refund the money by today. But how exactly does that work? Are people - should they expect a check? What's going on?

CAREY: This probably impacts the most people in the individual market that buy their own health insurance. About a third of those folks are entitled to a refund. If you're going to get a refund, you've most likely gotten a letter from your health insurance company already. There's about 13 million people that are going to receive about a billion dollars of refunds.

But there's a couple - of course, it's health care so it can't be straightforward. A few complications, here: If you get health insurance at work, your employer's going to get that rebate. Now, it has to filter through to you. For example, the employer might give you a lump-sum check. They might use it to reduce the cost of your premiums next year. They might use it to reduce your co-pays or deductibles, but it will filter through the system.

Another sticky thing here is that self-insured employers, that's about half - they cover about half of the nation's workers. They're exempt from this. And if your employer's self-insured, what they're doing is they're assuming all the risk. They pay all the claims. They might have a third-party administrator that administers it, but if they're self-insured, they are exempt from this.

MARTIN: And, you know, unfortunately, we really can't escape the politics of this because of a question like this. One listener on Facebook asked: What happens in states like Kansas, where the governor has decided to opt out of the program?

CAREY: Right.

MARTIN: So what does this mean?

CAREY: Kansas is one of 26 states that sued against the - sued the health law, challenged the constitutionality. And as we know, that has reached the Supreme Court, and they've ruled. So while the state could opt out of creating the health insurance exchanges, the marketplaces where people buy coverage in 2014 - or they could opt out of the Medicaid expansion, insurers still have to comply with all these new rules and regulations if they fall into the criteria there. It's one small section of insurers, grandfathered health plans that don't have to comply with these. It's a very small slice. But for most insurers, they will have to comply no matter what state they're located in.

MARTIN: If people had questions about this, what would you recommend that they do? If you live in a state where, for example, you know that there are legal challenges to the Affordable Care Act and you want to know where you stand in this conversation, what do you recommend?

CAREY: I would recommend they call the insurance commissioner. Most states have a health insurance commissioner's office, and I would recommend that they call that office, or go on the website. Do they have a place for consumers? I would assume that most insurance commission websites would address this very issue because of the confusion.

MARTIN: And finally, again, we saw a lot of protests, and particularly religious leaders, the Catholic Church - like, the bishops were particularly outspoken about some of these mandates, particularly the contraception mandates in the past couple of months. But we haven't seemed to have heard quite a lot now, and I'm wondering why that is.

CAREY: There was a decision made by the Obama administration to give these religious organizations a year reprieve from the requirement that went into effect today. That said, there are still lawsuits pending from these organizations. But one thing that is emerging is that some private businesses are saying, wait a minute. This violates my religious freedom. I don't want to do this. A Colorado judge gave a small business in that state an injunction against complying with this.

So not only are you going to hear it from religious organizations, you're also going to hear it from employers, as this case demonstrates.

MARTIN: Finally, what's the next deadline we should be watching for? August 1 was a big deadline, and the Obama administration made sure that we didn't miss it, taking what some reporters called a victory lap to highlight these provisions that go into effect - which do, as you said, affect, you know, millions of people. Is there another next deadline that we should be watching for?

CAREY: I think it's Election Day. Because if Mitt Romney wins the White House and Republicans take Congress, that would cause a lot of problems for the health care law. And conversely, you have a lot of Republican governors who've said I don't want my state to create a health insurance exchange. If President Obama's reelected and Democrats control at least one chamber of Congress, you might find some Republican governors saying that they will go ahead with the exchanges.

MARTIN: Mary Agnes Carey is a senior correspondent for Kaiser Health News. We want to say again, it is a nonprofit independent news service. It is not affiliated with the health insurance or HMO company. And she was kind enough to join us here in our Washington, D.C. studios. Mary Agnes Carey, thanks so much for joining us once again.

CAREY: Thank you. Transcript provided by NPR, Copyright NPR.