The Affordable Care Act and Reproductive Health
In the wake of the Dobbs decision, questions linger around ongoing access to critical reproductive health services. For example, access to contraception and the administrative barrier and burden of prior authorization continue to be points of concern for clinicians. The Affordable Care Act (ACA), health insurance reform legislation signed into law in 2010, is a source that clinicians can tap into to answer some of these questions.
Access to Contraception and Counseling
As part of the ACA, private payers are required to provide Food and Drug Administration (FDA)-approved contraceptive methods, sterilization procedures, and patient education and counseling for persons with reproductive capacity without copayment or other cost sharing requirements, with limited exemptions. Plans are required to cover, at no cost, at least one form of contraception within each of the contraceptive categories identified by the FDA. This was further reaffirmed in a letter sent by the Department of Health and Human Services to health insurance providers in June 2022. While plans cannot favor one type of method over another, they are able to apply formularies, prior authorization requirements, and similar restrictions within a method category. The ACA also requires that payers establish a system for contraception appeals sperate from other cases.
Patients can report if their payer is requiring them to pay out of pocket for contraception through the CoverHer Project at the National Women's Law Center.
Prior Authorization for Abortion Services
Prior authorization is often a large source of burden, administratively and financially, for clinicians and practices. With the confusion around the legality of abortion services in several states with exceptions only for the life of the mother, prior authorization of such services could provide even further delays in critical life-saving care. However, it is important to note that the ACA prohibits the use of prior authorization related to emergency care. This is an important component to consider as clinicians navigate new landscapes in the provision of abortion services.
Government Issued Guidance
- Departments of Labor, Health and Human Services, and Treasury Letter on Contraceptive Coverage Requirements for Private Insurance (June 2022)
- Departments of Labor, Health and Human Services, and Treasury issued FAQs on Affordable Care Act Requirements (July 2022)
- HealthCare.gov Preventive Care Benefits for Women