Posted by on November 25, 2012 - 1:46pm

As many as 129 million--or 1 in 2--non-elderly Americans have some type of pre-existing health condition, ranging from a life-threatening illness like cancer to chronic conditions like heart disease, diabetes, or asthma.   In most states, these individuals can be denied individual health insurance coverage or have benefits for certain conditions excluded by insurance companies.   Even if some small groups desire to cover all conditions, there is little that can be done to prevent exorbitant premium increases.

Starting in 2014, the proposed rule  of The Affordable Care Act (ACA) prohibits denying coverage because of pre-existing conditions.  It does state that individuals would have to buy coverage during open enrollment periods.  In addition, individual would have new special enrollment opportunities in the individual market when they experience certain losses of other coverage.

Health insurance issuers in the individual and small group markets would only be allowed to vary premiums based on age, tobacco use, family size, and geography.   All other facts--such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation and small employer size and industry---would no longer be able to be used by insurance companies to increase the premiums for those seeking insurance.

Under the ACA, states can choose to enact stronger consumer protections than the above minimum standards.  In addition, starting in 2017, states have the option of allowing large employers to purchase coverage through the Exchanges*.  For states that choose this option, these rating rules also would apply to all large group health insurance coverage.   These proposed rules standardize how health insurance issuers can price products, bringing a new level of transparency and fairness to premium pricing.

Health insurance issuers would be required to maintain a single statewide risk pool for each of their individual and small employer markets, unless a state chooses to merge the individual and small groups into one pool.   Premiums and annual rate changes would be based on the health risk of the entire pool.  This provision prevents insurers from using separate insurance pools within markets to get around the market reforms and to charge people with greater health problems higher rates for their pool,   than rates in other healthier pools (Note:   This practice has often been called "cherry-picking" , i.e, limiting certain pools to  healthy people in a.)

This proposed rule also covers individual and employee renewals, prohibiting issuers from refusing to renew coverage because an individual or employee suddenly becomes ill with a chronic or severe condition.  There is also a provision for enrollment in catastrophic plans, providing affordable individual coverage options for young adults and people for whom coverage would otherwise be unaffordable.  To see the proposed rule, visit

*Exchanges are the mechanism through which low and moderate-income individuals receive premium and cost-sharing subsidies to make health coverage more affordable. Many states have started implementing them, some have not.   They must be implemented by January 1, 2014.  In states who have not established an exchange, a federally-facilitated exchange will be implemented.  Some states are delaying action until all lawsuits against the ACA have been settled.



Posted by on November 14, 2012 - 2:42pm

The Patient Protection and Affordable Care Act has cleared two major hurdles in the recent past: the Supreme Court ruling on constitutionality and the reelection of President Obama. However, there is a very good chance that the Supreme Court has not seen the last of the health care reform law. Despite the bill's legal successes in the past, there are (at publication) more than 35 different cases on file against the contraception mandate in the bill filed by individual companies and religious organizations.

Thanks to the health care law, insurance plans are required to cover birth control and other women's preventive health services with no co-payments or deductibles at the start of their next plan year. For proponents of the bill, this means more health plans come under the law's reach, and that more women will be able to keep their wallets closed when they pick up their birth control.

Proponents further assert that gender equality means women having complete control over their reproductive lives. However, some organizations do not believe funding such services align with their organizational missions. Most filing amicus briefs are using the Religious Freedom Restoration Act, and it’s unanimous support by the Supreme Court, to say that the mandate violates religious organizations right to not pay for contraception.

The Religious Freedom Restoration Act requires that the federal “government may substantially burden a person’s exercise of religion only if it demonstrates that application of the burden to the person 1. Is in furtherance of a compelling governmental interest and 2. Is the least restrictive means of furthering that compelling governmental interest.”

Those in support of the mandate, like the American Civil Liberties Union (ACLU), believe that the mandate will be upheld. The ACLU specifically states in their amicus brief that the plaintiffs are trying to “discriminate against women and deny them benefits because of [the employer’s] religious beliefs.”

No matter where a woman falls in her beliefs about what the health reform bill should and should not require, it is clear that the Affordable Care Act still has many hurdles before full implementation. For more information about the impact of these state-level decisions on your contraception and access to reproductive health care, contact your local Congressional leaders and employer mission statements.

Posted by on November 6, 2012 - 11:23am

While the country struggles to provide affordable, quality health care to all Americans, a primary focus has been on women and children. However, one group of care providers is rarely discussed by health policymakers despite their significant contributions to health care: Midwives.

Certified nurse-midwives (CNMs) and certified midwives (CMs) provide high quality primary and maternity care to women and families. CNMs are recognized under federal law as primary care providers for women. They provide family planning services, gynecology services, primary care, childbirth and postpartum care, care of children for the first 28 days of life, and treatment of male partners for sexually transmitted infections. Midwives also use their credentials to prescribe medication, admit, manage and discharge patients, and interpret laboratory and diagnostic tests. These skills allow midwives to offset many of the primary and maternal care functions of MDs, and do so with lower costs.

The Institute of Medicine published in its report The Future of Nursing that critical workforce shortages are being seen across all health care systems, especially in primary and maternity care. There is a vast amount of literature that suggests CNM and CM professionals provide a high-value, cost-effective, patient-centered form of care in exactly those arenas. As 2014 and greater implementation of the Affordable Care Act nears, access to midwives is ever increasing, with the Affordable Care Act granting midwives 100% reimbursement under Medicare Part B. Further, new nondiscrimination requirements have been employed to ensure that individual and group health insurance plans must cover these services for women.

Nevertheless, many stakeholders including clinicians and policymakers are unaware of or fail to discuss the significant role midwives will play in health reform. Nor are they adequately addressing how barriers to their practicing medicine continue to play out in the medical world. It’s about time we make sure all women’s preventative and maternal services are given full attention and made effective.

Posted by on September 27, 2012 - 9:55am

The 2012 election cycle has seen unprecedented coverage (and often misinformation) on women’s reproductive health care due to the Affordable Care Act’s immediate impact and nonstop campaign gaffes related to women’s health.

Last Thursday, the National Women’s Law Center (NWLC) launched a new campaign to improve access to women’s health information called This Is Personal. The mission of the campaign is to target, engage and inform younger women about reproductive rights and help disseminate information related to women’s health topics ranging from contraception, maternity care, and what Congress is presently voting on.

It is therefore vitally important that women get involved in the decision-making process to ensure that the women impacted by these deeply personal issues have real world input.  “Decisions about women’s reproductive health are personal. Period.” said NWLC Co-President Marcia Greenberger. “These decisions should be a woman’s to make with the important people in her life. The personal beliefs of lawmakers should not trump a woman’s ability to take care of her health.” Despite the private nature of decisions impacting reproductive health care, they are often made at the federal, state or local levels instead of the individual level.

The This Is Personal campaign hopes that through social media, celebrity involvement in videos and satire, young women (and men) will become increasingly active and interactive about reproductive rights. For example, through the new website’s interactive action tabs women can gather more information about state and federal health care decisions, sign petitions and contact legislators.

Decisions about women’s reproductive health care are greatly personal and deserve intimate involvement from women themselves. This Is Personal has a Facebook, Twitter and website with data and satirical videos which should be used as an educational tool and a place for women to educate themselves for the upcoming election. It is also a place where women can actively use their beliefs and knowledge to have their voices heard by decision makers.  Sharing of ideas and knowledge is the only way to put decision making into the hands of the women who will be affected by the policies of the 113th Congress.

Posted by on August 1, 2012 - 12:52pm

A hotly contested provision of the Affordable Care Act (ACA) that requires employers and insurers to offer free contraceptive coverage takes effect today despite ongoing legal challenges.

Starting August 1, 2012, all new insurance policies must cover birth control and certain other preventive health services with no copay, coinsurance, or deductible. The move has riled political conservatives who say it encroaches on their religious freedom by forcing some faith-based employers to provide contraceptive coverage against their will.

While efforts to repeal the change in Congress seem to have cooled, some legal challenges (in Colorado and Michigan)  are still under way to the law, which has already been delayed for certain faith-based organizations by the Obama administration.

Other women's health services for which mandated coverage begins Wednesday include free annual breast exams, prenatal care, HPV screenings, and pelvic exams. Although the changes take effect today, insurance plans won't be required to start providing the free contraception until the insurance plan's next renewal date -- Jan. 1 for most plans.   Unfortunately, many state plans were renewed July 1 so it may take a full year to implement everything mandated by the ACA.    The Department of Health and Human Services estimates 47 million women will be effected by the ACA's mandate.

Despite some Republican concerns about the birth control mandate, they have yet to take a vote in the House of Representatives.  Efforts to repeal parts of or the entire ACA have stalled in the Democratic-controlled Senate, despite repeated efforts by the House.

But the Obama Administration has already taken steps to soften the change. A final rule issued in March says religious colleges and universities who object to contraception do not have to pay for or arrange coverage for their students or employees.

In addition, all nonchurch religious organizations that object to the policy don't have to pay for birth control; instead, their health insurers would be required to reach out to beneficiaries separately and offer such coverage free of charge. Religious organizations such as churches are exempt from the rule entirely.


Posted by on July 21, 2012 - 2:14pm

Several Affordable Care Act  provisions that have "remained under the public's radar" are women's health-related, according to a Kaiser Health Newslist of 10 little-known elements of the law. The following is from the Daily Women's Health Policy Report from the National Partnership for Women and Families.

One such provision reauthorizes funding through 2014 to states for sex education programs that teach students that abstinence is "the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems."

Another provision calls on the National Institute of Mental Health to conduct a study on the causes and effects of postpartum depression. The law also authorized $3 million in 2010 and more funds as needed in 2011 and 2012 to support services for women at risk of postpartum depression.

The health reform law also requires employers with 50 or more workers to provide women who are breastfeeding with a private location to pump and "reasonable break time" to do so.

Another section in the law requires CDC to carry out an educational campaign targeted at young women about "the occurrence of breast cancer and the general and specific risk factors in women who may be at high risk for breast cancer based on familial, racial, ethnic and cultural backgrounds such as Ashkenazi Jewish populations" (Schultz/Torres, Kaiser Health News, 7/12).