TOPICS > Health

Affordable Care Act Benefits Begin Roll Out, Including Women’s Preventative Care

August 1, 2012 at 12:00 AM EDT
Some benefits outlined in the Affordable Care Act begin this week, including preventative services for women. Covered benefits include OB-GYN visits, HIV and other STD testing and birth control. Margaret Warner talks to NPR's Julie Rovner about the latest updates regarding health care reform.

GWEN IFILL: Next, an update on new benefits taking effect today under the federal health reform law.

Margaret Warner has the story.

MARGARET WARNER: Two new provisions in the Affordable Care Act kicked in today.

New or renewing health insurance plans must now cover eight preventive services to women at no out-of-pocket cost, including annual OB-GYN exams, birth control, breast-feeding counseling, and screenings for sexually transmitted diseases and HIV.

And today was the deadline for insurance companies to distribute some $1.1 billion in rebates to some individuals and companies. The rebates had to be paid by insurers who didn’t spend at least 80 percent of the premiums they’d charged on medical care.

To walk us through this is Julie Rovner of NPR.

And, Julie, welcome back.

JULIE ROVNER, NPR: Nice to be here.

MARGARET WARNER: So, just to be clear here first on the women’s services, so all of these services must be provided to any woman who has health insurance with — she will pay nothing?

JULIE ROVNER: She will pay for it in her premium. She will pay nothing up front. So the money will be included in the premiums that people pay, that men and women will pay.

But women will not have to pay any deductible or any co-pay at the time she receives the services. People talk about it as being free. It’s just no up-front cost for these services. And it does include birth control.

MARGARET WARNER: And how many women potentially are affected and when will they start to see these changes?

JULIE ROVNER: Well, they should start to see the changes either right away, if they get new policies, or when the next time their policy renews.

So, some people, that will be this fall. Some people, it will be next January. Some people, it be could be as long as a year. And the Department of Health and Human Services estimates that there are 47 million women who will be affected by these changes.

MARGARET WARNER: So if 47 million women can pay no up-front costs for say something fairly expensive, like a full OB-GYN annual visit, how will the insurance company cover the cost, and who is going to pay?

JULIE ROVNER: Well, as I say, it gets built in to the cost of everybody’s policy.

The estimates, though, are that these costs are going to be relatively de minimis.

Preventative care really isn’t that expensive. In case of birth control, for instance, the money that gets saved by not paying for women who get pregnant is vastly — it is vastly less expensive to pay for birth control than it is to pay for a woman’s pregnancy.

So, generally, that’s considered a cost-saver. Most preventive care is really not particularly expensive.

MARGARET WARNER: What was the objective here to having these services with no out-of-pocket costs for women ?

JULIE ROVNER: Basically, to encourage people to go and get them.

And that’s been — this has been a trend that has been — the insurance industry has been moving towards in any case. And employers, when they have plans, have been urging people, have been trying to make it easier for people to get preventive care by making it — by making it less of a cost up front.

And, indeed, they have found when there is less of a cost up front, people do tend to get preventive care more.

MARGARET WARNER: So now contraception, you have mentioned that a couple of times.

Despite the partial exemptions that the president and the administration put in for religious institutions, this still remains very controversial. What’s the status?

JULIE ROVNER: It does remain very controversial.

There’s several lawsuits that are pending. What the status is, is that churches — houses of worship themselves are exempt from these rules.

Religious organizations like hospitals, universities, social service agencies, are not exempt, but they have been given an extra year while the administration tries to work out some kind of compromise where perhaps the insurance company would have to pay for it.

They’re still working on that. And a couple — many of them have sued, and the lawsuits have been deemed premature, because they’re working on a compromise. There’s a third round of lawsuits from private companies saying, well, I’m a private for-profit company, but I just don’t want to offer it because I don’t believe in that.

There’s been so far one federal judge and one company in Denver that’s been stayed for that one company. We’re waiting to see about that.

MARGARET WARNER: Now, the insurance rebates, totally separate development.

How many individuals and how many employers who run employer-paid health plans are going to share in this $1.1 billion?

JULIE ROVNER: They think it’s about 12.8 million people will have some share in some sort of rebate. The rebates will vary dramatically, but for the people who get them, the average will be about $150.

And this is basically for companies who in calendar year 2011 failed to meet this requirement of spending at least 80 cents, or in the case of large group plans 85 cents, of every dollar on actual medical care, as opposed to administrative costs or profit.

MARGARET WARNER: And so, if you’re an employer, in an employer plan, though, you may not necessarily get a check.

JULIE ROVNER: That’s right. But you will have gotten a letter by now that says that your employer is getting a check.


JULIE ROVNER: And then the employer has to decide how to give it back to you, whether to refund it to you in the way of a check or to perhaps offset next year’s increases or to give you some other way — find some other way to make a benefit available to you.

So, if you pay in, you will receive a letter as of today that says we’re giving you some money back.

MARGARET WARNER: Now, the designers said the reason for this was to reduce overhead costs, make sure the companies did. What, if anything, has been the impact? Is it too soon to say, or can you see some impact?

JULIE ROVNER: Well, it’s a billion dollars that is coming back to policy holders. So there’s been that impact.

It’s too soon to say whether there’s been any real change in behavior on the part of insurers. But certainly there’s a political impact here, which is that people who have insurance are seeing, hey, this law is doing something for me in the sense of it’s holding insurers’ feet to the fire in terms of what they’re providing. At least, that’s the intent.

MARGARET WARNER: And before an election.

JULIE ROVNER: That’s not an accident either.

MARGARET WARNER: Julie Rovner of NPR, thank you.

JULIE ROVNER:  You’re welcome.