July 18, 2024

Women are still being charged for contraception even though federal law dictates it should be free. The chair of the Senate health committee wants a government watchdog to investigate why.

Under the Affordable Care Act, health plans are required to provide birth control to patients as a preventive service. Repeated probes have found that plans flout the law and patients are asked to pay, Sen. Bernie Sanders (I-Vt.) said in a letter being sent Monday to the Government Accountability Office and shared with The Washington Post.

“It is completely unacceptable that plans consistently defy mandated coverage and that there is little enforcement or accountability,” Sanders wrote to GAO leader Gene L. Dodaro, asking him to open an investigation.

Democrats have pushed to ensure access to contraception amid broader challenges to reproductive health services. Senate leaders last week held a vote intended to enshrine contraception as a federal right; the measure failed amid Republican opposition. Far-right conservatives have attacked birth control by inaccurately characterizing various methods as causing abortion, and contraception access has faced funding challenges at the state level.

“I’m extremely worried, honestly,” said Rachel Fey, vice president of policy and strategic partnerships at Power to Decide, a nonprofit group focused on reproductive health, saying she fears contraception access is facing “death by 1,000 cuts” and that plans’ failure to comply with federal law is making it worse.

“There’s nothing more frustrating than hearing that this is still happening more than a decade after this provision went into effect,” Fey said. “If people are still not getting the contraceptive coverage they’re entitled to, this becomes … an enforcement issue.”

In his letter to GAO, Sanders cites a recent investigation by the state of Vermont that found three insurers wrongly charged residents more than $1.5 million for contraception. A 2022 investigation by the House Oversight Committee found that health insurers persistently denied their members’ requests for no-cost contraceptives. Some insurers deny coverage for certain brand-name contraceptives, saying they cover generic versions that are therapeutically equivalent. But insurers are required to offer a process for women to access contraceptives that physicians deem medically necessary.

Sixteen percent of privately insured contraceptive users were still paying out of pocket in 2022, according to polling by KFF, a nonpartisan health research organization.

“The intention of the policy is full coverage for women’s contraceptives, but the implementation has been complicated, just because there are so many contraceptive methods,” said Brittni Frederiksen, a KFF associate director who works on reproductive health policy. Under the law, health plans are required to cover at least one form of contraception in each category of birth control, such as oral contraception — but there are hundreds of oral contraceptive pills that providers might prescribe for their patients, Frederiksen said.

“Writing [regulations] that cover all of those things without saying you essentially have to cover them all is challenging,” Frederiksen said.

The Biden administration took several steps in January intended to shore up access to contraception. Health and Human Services Secretary Xavier Becerra sent a letter to health insurers instructing them of their obligation to provide no-cost contraceptives, and HHS and the Treasury and Labor departments issued further guidance on how to implement federal requirements.

Fey said the Biden administration could go further to collect complaints from women facing barriers to contraception access. She pointed to the administration’s recent efforts to simplify how patients can report if they were denied emergency abortions or other emergency care.

“I would love to see the administration do something similar” for contraception, Fey said. “To really make it user-friendly for people to say, ‘Hey, I think I’m not getting the contraception I’m supposed to be getting.’”

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