04.28.15

Murray to Insurers: Failure to Cover, Inform Women About Contraceptive Health Care Is “Unacceptable”

Murray writes letter to eight Washington state insurers about failure to provide approved contraception, accurate information on Washington Healthplanfinder

Murray: “A lack of consumer awareness and transparency about what is covered for women is unacceptable.”

(Washington, D.C.) – Today, Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Patty Murray (D-WA) sent a letter to eight health insurance companies offering coverage on Washington Healthplanfinder in Washington state expressing her concern that the insurers were failing to cover forms of contraception approved by the FDA and failing to provide women with accurate information about the services available to them under the Affordable Care Act. The concerns were based off of a recent report by the Northwest Health Law Advocates and NARAL Pro-Choice Washington, which surveyed the eight health insurance companies that offered qualified health plans on Washington Healthplanfinder.

Murray urged the insurers to be proactive and increase transparency for the women and families they serve, and requested a written update on each plan’s action steps to correct coverage and improve consumer awareness for women in Washington state.

“I write to express strong concern about these developments and urge you to come into compliance with the law immediately…” Murray wrote in the letter. “A lack of consumer awareness and transparency about what is covered for women is unacceptable.  A benefit that’s hidden from consumers is the same as having no benefit at all. Insurers must do their part to provide accurate information to all Washingtonians.”

The letter was sent to BridgeSpan Health Company, Coordinated Care, Kaiser Permanente Northwest, Molina Healthcare of Washington, Community Health Plan of Washington, Group Health Cooperative, LifeWise Health Plan of Washington, and Premera Blue Cross. 

Full text of the letter:

I believe strongly that, in the 21st century, women should be able to exercise their constitutionally guaranteed right to make their own health care decisions. The Affordable Care Act (ACA) was intended to empower consumers, including women, by expanding access to better choices for health insurance coverage.  Importantly, the ACA expanded contraception coverage without cost-sharing, which has helped empower women and their families.  Already, 30 million women across the country have benefited from this provision and saved over $483 million in out of pocket costs.

Unfortunately, a recent report from the Northwest Health Law Advocates and NARAL Pro-Choice Washington, as well as media coverage (JoNel Aleccia, “Women getting bad info on birth-control coverage from ACA Insurers,” The Seattle Times, April 16, 2015) indicate that certain Washington state health plans are failing to cover all FDA-approved forms of contraception at no cost and are failing to provide women with accurate information about the services available to them. Over 54 percent of Washingtonians enrolling in health insurance through Washington Healthplanfinder are women, making these reports particularly alarming.  I write to express strong concern about these developments and urge you to come into compliance with the law immediately.

Federal regulations implementing the ACA require that qualified health plans (QHPs) provide coverage without cost sharing for a broad set of preventive services specified in guidelines from the Health Resources and Services Administration. These federal guidelines specify that QHPs must cover all FDA-approved contraceptive methods, ensuring that women get value for their premium dollar – which means full access to the contraception method that best meets their health needs. This no-cost access is crucial to women’s health.  Research shows that costs can significantly restrict women’s ability to get the right care. In fact, almost one third of women report they would change their form of contraception if cost were not a factor.

I am extremely disappointed to learn from the Northwest Health Law Advocates/NARAL report that not a single health insurance company offering QHPs on Washington Healthplanfinder consistently told consumers about the no-cost coverage of all FDA-approved methods under the ACA. In general, I was pleased to learn that overall insurers did not require cost-sharing for most contraceptive methods. However, a lack of consumer awareness and transparency about what is covered for women is unacceptable.  A benefit that’s hidden from consumers is the same as having no benefit at all. Insurers must do their part to provide accurate information to all Washingtonians.

The report also found that some insurance carriers’ QHP formularies categorized certain forms of contraception like IUDs, which have shown to be 45 times more effective than oral contraceptives and 99.9% effective in reducing unintended pregnancies, on higher priced drug tiers or excluded them entirely. While these are new forms of contraception that carriers may still be integrating into their formularies, they are also the most effective in preventing unwanted pregnancy and provide women and their families with security.

It is critical that women in Washington have full access to the health care services they are entitled to under the law.  I urge you to take the following proactive steps, and work with the Washington insurance commissioner, Washington Healthplanfinder, and Congress, to ensure that consumers have full information about their guaranteed health insurance benefits:

  • Ensure that all sales and customer service representatives receive training on all benefits, including contraception benefits;
  • Update formularies regularly, making sure that they are accurate and compliant with the ACA requirements on contraception coverage;
  • Make sure that formularies accurately list all medical methods of contraception and that consumers can find information on methods easily; and
  • Help provide consumers with greater access to medical information about contraception methods to support informed decision-making and full range of choice.
  • Additionally, carriers should consider providing emergency contraception without cost-sharing regardless of whether a woman has obtained a prescription, as it is both a beneficial and cost-effective option for women and carriers alike.

I am pleased to hear that you have made a written commitment to work with Insurance Commissioner Mike Kreidler to resolve these issues and move forward. I urge you to continue to be proactive and increase transparency and information-sharing for the women and families you serve.  I will be monitoring your progress toward ensuring that women receive the information and contraceptive benefits to which they are entitled.

I request an update in writing on your action steps to correct these issues for women across Washington state immediately. If you have questions, please contact Melanie Rainer of my staff at (202) 224-0767.

Sincerely,

Patty Murray
U.S. Senator

cc: Dr. Mike Kreidler, Commissioner, Washington State Office of the Insurance Commissioner

Dr. Richard Onizuka, Chief Executive Officer, Washington Health Benefit Exchange