Light or Heat in the Controversy over Guidelines for Implementation of Health Care Reform

Much ink has been spilled in the past few weeks about the “war on religion” and the purported White House campaign to force people of faith (and specifically Catholics?) to have abortions, use contraceptives, and/or pay for others to do so. Far too much of this conversation is taking place in both figurative and literal shouting matches. Much heat … very little light!

Opponents of the Patient Protection and Affordable Care Act (PPACA) see the most recent guidelines regarding preventive services for women as a specific attack against the religious liberty of institutions such as Catholic hospitals, universities and charitable organizations. Proponents of this law, also known as the Affordable Care Act (ACA), point out that no one is in fact forced to use any of the preventive services covered. They note that exemptions are in place for churches, but they insist that to the extent that religious groups are employers, do not exist primarily to teach religion, serve non-members of that religion, and hire non-members of the religion, those groups are subject to employment laws just as other employers are.

The administration has moved to defuse this issue by ruling that the new preventive care services recommended by the independent Institute of Medicine and now mandated as benefits for women will be provided by insurers with no collection of premium from employers or employees. While many of those employers who will be impacted expressed initial support for this solution, some did not, so the controversy continues to rage.

Some of the comments I have heard on this subject indicate a broad lack of knowledge of basic facts about the PPACA and its provisions. Two specific issues seem to be causing the majority of complaints/upset among the general public: 1) coverage/support for pregnancy and 2) misidentification of contraceptives with abortifacient drugs.

Since so much heat is being generated on the topic, I did some research on them myself. This is what I found.

1. Maternity care and newborn care are classified as “essential health benefits” under PPACA. They MUST be covered by all insurance plans by January 1, 2014.

Currently, at least in California, most policies do not offer this coverage at any price and women who have non-maternity policies and become pregnant, are considered to have a pre-existing condition that prevents them from moving into a policy that offers maternity care. This will change in California effective July 1, 2012. However, at least one major insurer will require that women be covered for at least 12 months before maternity care will be covered with no exclusion period. Women who have not been covered for at least 12 months prior to becoming pregnant will have a six month exclusion period for their maternity care, thus increasing the risk of birth defects and complications of pregnancy for those who get no care or minimal care during the critical early months of pregnancy.

Nationally, coverage for maternity care will be required in all policies effective January 1, 2014. Requiring coverage for maternity care can be expected to reduce the number of birth defects, complications of pregnancy, and even abortions, because low and middle income women will not have to bear the entire cost of their prenatal and delivery care.

2. Abortifacients are not covered drugs under the new preventive care guidelines regarding provision of women’s health care services at no cost to the woman.

One other serious misconception I’m hearing is that the Catholic Bishops are opposed to the Obama administration and its policies in general. This is also false.

Here are the articles I found and the links for your own research and other questions regarding:

1) the relationship of the Catholic Bishops and the Obama administration

2) PPACA’s guidelines and implementation.

Information about the position of the Bishops and the administration – quoted from an interview by John Allen, Jr. with Archbishop Dolan of the United States Catholic Conference of Bishops.

From: National Catholic Reporter

“Bishops are not ‘Obama haters,’ Dolan insists”

By John L. Allen, Jr. on Feb. 14, 2012

“Do you believe that Obama is waging a war on religion?

I don’t want to believe that. I find myself agreeing with many of President Obama’s policies. I find myself believing him when he assures me that he has the highest regard for the work of the church, especially in health care, education, and works of peace, charity and justice. I want to believe him when he says he wants this administration to do nothing to impede that good work, and that he considers the protection of conscience and freedom of religion to be one of the highest calls that he has as president, to protect the constitution. I want to believe him. I have to say that sometimes he makes it hard to believe him, but I will not place myself or my brother bishops in the camp of Obama-haters, because we’re not.

Anybody familiar with the history of the Catholic church knows that with every single President of the United States, we’ve applauded some things that he’s done and we’ve sat on our hands for others. It’s no different now. This may be one of the more well-oiled and effective protests that we’ve waged to something a president has done, which is why it’s getting attention, and I’m glad it is. But that doesn’t make us bullies who are now trying to impose our beliefs on the rest of the country, and trying to utilize the offices of the federal bureaucracy to do that. I would say that we’re not the ones imposing anything here. We didn’t start this battle, and I’m kind of uncomfortable with it. I don’t like battles. I know it has to be part of our ministry. I’m going to be reminded on Saturday that sometimes we have to do battle at the cost of blood in defense of the faith, but we’d much rather be conciliatory. We’d much rather be cooperative.

When I went into the Oval Office in November, the first thing the president did is to say, ‘Archbishop Dolan, let’s rehearse the areas in which my administration and the Catholic community in the United States is cooperating.’ He went into a litany of about ten minutes, and all I could do was nod my head in agreement. I also added a few more he had forgotten. It’s not like there’s total conflict, and I want to get that out. Strategically, we do not need to be painted into a corner where we’re some bully, obstinate bishops who do not want to dialogue or have any posture of openness to this administration. More importantly, it’s factually not true.”

To read more, see:

http://ncronline.org/blogs/ncr-today/bishops-are-not-obama-haters-dolan-insists

Regarding the Patient Protection and Affordable Care Act (PPACA) – These three excerpts provide specific information on requirements of the act.

From: Health Reform Whitepaper: Employer Impact of PPACA

6/28/2010  Health Law Monitor  – Jackson Kelly PLLC

“What precisely constitutes ‘essential health benefits’ is to be more fully defined by future guidance. But PPACA lists the following broad categories of essential health benefits: ambulatory patient services, emergency services, hospitalization, maternity and newborn care [emphasis added], mental health and substance use disorder services, prescription drugs, laboratory services, preventive and wellness and chronic disease management, and pediatric services (including oral and vision care). Note that oral and vision care for adults are likely not essential health benefits.

Group health plans may place lifetime and annual dollar limits on benefits that are not “essential health benefits” (i.e., PPACA does not affect non-essential benefits).

Effective Dates. This provision is effective for plan years beginning on or after September 23, 2010, except restricted annual limits on essential health benefits will be allowed until January 1, 2014. For plan years starting after 2014, annual dollar limits on essential benefits are prohibited entirely. Also applies to grandfathered plans.”

For the entire article, see:

http://healthlawmonitor.jacksonkelly.com/2010/06/health-reform-whitepaper-employer-impact-of-ppaca.html

A chart is included showing changes required for all employer paid health plans and those for non-grandfathered plans only.

Note: many plans are grandfathered; their benefits remain unchanged for the most part. Only if an employer or covered individual changes plans do the non-grandfathered provisions take effect. However, some changes are required for all policies and most of the beneficial reforms of the new law are in favor of the insured!

From: Affordable Care Act Rules on Expanding Access to Preventive Services for Women – Healthcare.gov

“Additional women’s preventive services that will be covered without cost sharing requirements include:

• Well-woman visits: …
• Gestational Diabetes screening: …
• HPV DNA testing: …
• STI counseling & HIV screening & counseling: …
• Contraception and contraceptive counseling: Women will have access to all Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling. These recommendations do not include abortifacient drugs. [emphasis added] Most workers in employer-sponsored plans are currently covered for contraceptives. Family planning services are an essential preventive service for women and critical to appropriately spacing and ensuring intended pregnancies, which results in improved maternal health and better birth outcomes.
• Breastfeeding support, supplies & counseling: …
• Domestic violence screening: …”

For more information, see:

http://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html

From: Song Mondress PLLC

October 2011 – Bulletin: Recent Developments in Employee Benefits Law

New Guidance Related To Health Plans & Health Care Reform (PPACA)

“New Women’s Preventive Care Guidelines Issued

HHS recently issued guidelines setting forth additional types of women’s preventive care under PPACA’s preventive care requirements for non-grandfathered health plans. These additional types of preventive care must be provided with no cost-sharing, effective as of the first day of the first plan year beginning on or after August 1, 2012. The guidelines are available at http://www.hrsa.gov/womensguidelines/. New types of required preventive care include, for example:

• FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity. (Abortifacient drugs – e.g., RU-486 – do not qualify as contraception.) [emphasis added ] Group health plans sponsored by religious employers, and insurance coverage offered with respect to such plans, are not required to provide this care.
• Breastfeeding supplies, support and counseling.
• HPV testing every 3 years, beginning at age 30.
• Annual HIV counseling and screening for sexually active women.
• An annual “well-woman visit” to obtain all appropriate preventive services, and additional well-woman visits if the patient and her provider determine the visits are necessary.

As with other types of preventive care, plans may use reasonable medical management techniques in providing the care described in the new guidelines. For example, plans can continue to impose cost-sharing for brand-name drugs if an equally safe and effective generic version is available.”

For the entire report see:

http://www.songmondress.com/Articles/Bulletin-Recent-Developments-in-Employee-Benefits-Law.shtml

 Reprinted with permission from Advanced Knowledge Resources.com