Religion and Contraceptives as Part of Essential Health Benefits

So, technically, HHS has come up with what it considers a “solution” to the “we won’t pay for contraception” argument put forth by certain religious organizations. For consumers it means that TECHNICALLY, if the proposed rules go through as delineated that female employees who work for covered religious organizations WILL have access to contraceptives as a part of the essential health benefits preventive services Affordable Care provides to women.

The general solution provides for a third-party, another insurance company to provide contraception and preventive services coverage if a religious organization doesn’t want its own insurance company to provide such benefits.

But there’s a pattern emerging here and it goes back to the divergent goals of consumers, health insurance companies and the government. The government wanted more people insured based on the assumption that having health insurance would improve healthcare. However, the immediate goal was to get more people insured. This is why the PENALTY TAX for uninsured individuals made it through while early on the public option for health insurance was tossed by Affordable Care advocates.

Making such insurance affordable, not health care, but health insurance is the reason we see so much consideration of paying for health insurance rather than the costs of health care which remain largely unfettered. This is the Achilles heel of the Affordable Care Act.

Without effective controls on the cost of health services, we’re in a relentless chase between paying for insurance that is intended to cover us for needed health care that we can’t afford even with health insurance in many instances. This inability to cover health care costs through health insurance means that insurance companies keep raising their premiums charged for health insurance coverage and in the case of the Federal government, it means that government will reduce its costs of providing health insurance through Medicare or Medicaid by slashing benefits and increasing costs to consumers.

With Obamacare now law, we’re seeing that the assertion in the above paragraph is no longer a guess, but is in fact how the costs of providing health insurance are being managed. Health insurance costs are going up and the “sharing” of costs is costing consumers more than ever before in insurance premiums. The bone we’ve been thrown is that certain rules will apply to this product we’re purchasing including the infamous removal of lifetime limits and the provision of “no-cost” essential health benefits. As our experience unfolds, we’ll find that the commitment to having more people insured is PRIMARILY balanced with a need for the Federal government to make sure it can continue to FUND its dream of Obamacare, which in turn is the dream of having people insured. Quality, accessibility, and affordability to consumers have already been relegated to the backseat of priorities when it comes to health insurance reform.

Since Obamacare, we’ve seen leniency in deadlines. We’ve seen leniency in allowing for greater deductibles (more money paid before insurance benefits cover individuals at promised levels) for some insurers who claim that they won’t be able to afford to provide essential health benefits without such increases in money taken from their insureds. We see it with the cash is king rules put out by HIPAA allowing individuals to pay for their own services and bypass their insurance company in the hopes of achieving greater privacy for their personal health information. And now we’re seeing it with contraceptive services.

In the face of a conflict of religion and Federal law, specifically the Patient Protection and Affordable Care Act, and the inclusion of contraceptives as part of essential services for which employees cannot be charged co-payment or deductible costs, some religious organizations want to maintain their ability to offer Qualified Health Plans without having to comply with offering contraceptive services.

Contraceptives are considered “preventive services” under the Affordable Care Act.

On 2/1/13, HHS issued its proposed accommodation to keep the peace between religion and government. You can read the article entitled, “Administration issues Notice of Proposed Rulemaking on recommended preventive services policy,” on the HHS website.

While it’s debatable whether anything is ever free or “included” in your insurance coverage (as expressed previously in many of my posts regarding increased costs of health insurance coverage that frequently goes hand in hand with less coverage for illness, a lose-lose situation), there is a “policy” message that the ACA tried to communicate through its provision of no cost sharing for certain preventive services for women, a pro-female rights message that has rubbed many religious organizations the wrong way on similar “policy” grounds concerning their views about reproductive rights.

The clash has resulted in a mean-spirited debate that includes articles that you can look up including threats of firing for employees who use contraceptive coverage.

HHS in its January 2013 announcement intends to accommodate the religious organizations by providing a convoluted way for non-profit, religious organization employees to have access to contraceptive coverage while not requiring that the religious organization pay for insurance that provides such coverage through the use of separate policies arranged for by the insurance company with another insurance company that would provide such coverage at no cost to the religious organization or its insured employees.

The cost of the insurance coverage would be borne by the insurance company for the non-profit organization which supposedly would reap the benefits of providing such coverage from another insurance company in terms of reduced costs for other medical services that might be required by women denied free preventive services coverage such as for illness or increased number of childbirths which the Affordable Care Act assumes would increase without such coverage.

Self-insured group health plans are also required to provide the benefits to women (excluding certain educational institution self-funded plans because students are not employees and therefore those plans are excluded). The separate coverage provided by these plans would be paid for by the insurance companies which would be eligible for an adjustment (reduction) to their Federally-facilitated Exchange user fees.

Interestingly, the issuance of these proposed rules follow closely on the heels of allegedly improved “privacy” rights for patients. As previously noted here and in the numerous reports of breaches of patient privacy that you can research, privacy protections are grossly inadequate and therefore, breaches of patient privacy are bound to also impact those who work for religious organizations who choose to use the contraceptive coverage. Neatly available, is the option for purchasing contraceptives without going through insurance under the new HIIPAA provisions which allow individuals to pay for privacy and avoid insurance company notification.

So what has HHS really provided? HHS has created an opportunity for insurance policies of protected religious organizations to technically comply with the law without compromising their policies of not paying for contraceptives. HHS has created an opportunity for the government to say it’s been sensitive to religious organizations and has honored the requirements of Affordable Care. But for women? Those who dare to use the separate insurance for birth control are provided with no additional protections of privacy. Interestingly, the only improvement to consumer privacy is the option to bypass insurance companies by paying for services out of pocket. Women who value their privacy will NOT use the contraceptive insurance provided if they work for religious organizations once they consider that a breach to their privacy leaves them with little recourse aside from bringing their own lawsuit. In other words, HHS timed its announcement of the privacy available by paying out-of-pocket for healthcare services and products therefore removing insurance company notification very well as an important provision for women to consider before electing to use the third-party insurance coverage for contraceptive services if they work for religious organizations. Unfortunately, paying for a healthcare service out of pocket means that it isn’t covered by insurance in terms of reality.