Tuesday, April 18, 2023

An Insight into Application of ACA Preventive Services Law: House Report on Birth Control Coverage

The Affordable Care Act mandates coverage of preventive services, including contraceptives, by commercial health insurance, as endorsed by the USPSTF and two other bodies. A US House report from October 2022 examines "inappropriate" non-coverage or copay requirements for some contraceptive methods, raising questions about similar issues in other healthcare verticals like preventive diagnostic tests.


The Affordable Care Act requires commercial health insurance to cover preventive services endorsed by the USPSTF, or by two other bodies.  The other bodies are a vaccines committee at CDC, and a women's health committee at HHS.    It is the women's health body (not USPSTF) that makes contraceptive services an ACA preventive health benefit.

While there are plenty of legal cases and rulemakings navigating around contraception and religious freedoms, in general, the HHS interpretation is that health plans must cover all contraceptives or contraceptive methods endorsed by the HHS group.   (Similarly, on the USPSTF side, I believe plans are required in principal to cover all colorectal screening methods endorsed by USPSTF).   

A report from the US House of Representatives was released in October 2022 (that is, under Democratic leadership at that time in the House), and looks at "inappropriate" non coverage or requirements for copays for some contraeptive methods.   I mention this, on this blog, because similar issues may apply in other healthcare verticals, such as preventive services with diagnostic tests.

Beyond that, I'm not an attorney, and I'll leave interpretations of correct, or incorrect, non coverage to readers.   Here's the House PDF document on noncoverage and improper copays:


See a May 2022 WaPo article on the topic:


See a July 2022 HHS press release on the same topic:


See an October 2022 news article based on the then-new House report:


See a 2023 policy note at KFF here.  See a 2021 report on the same topic (same news) in 2021 here.

Summary at top generated by GPT4.

Pic, bing.com/create