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For Women, Benefits Could Be Fewer And Insurance Costs Greater Under TrumpCare

Mayra Del Real, 28, holds her newborn baby. Guaranteed coverage of maternity services on the individual insurance market could be on the chopping block under the new administration. (Heidi de Marco/KHN)

As the prospect began to sink in of losing access to free contraceptives if the health law is repealed or replaced, women reportedly have been racing to get IUDs or stockpile birth control  pills before President Barack Obama leaves office.

But other women’s health benefits also are at risk. At or near the top of the list is guaranteed coverage of maternity services on the individual insurance market.

Before the health law, it was unusual for plans in the individual market to pay for maternity services. But the Affordable Care Act required such care be covered as one of the 10 essential health benefits.

In 2009, the year before the health law passed, just 13 percent of individual plans available to a 30-year-old woman in all the state capitals offered maternity benefits, according to an analysis by the National Women’s Law Center.

Some plans offered maternity services as an add-on through a special rider that paid a fixed dollar amount, sometimes just a few thousand dollars, the study found. But a woman’s expenses could be much higher: The average total payment for a vaginal birth was $18,329 in 2010, according to a study by Truven Health Analytics.

Also before the law, women were generally charged higher rates for health insurance on the individual market. According to the National Women’s Law Center’s analysis, 60 percent of the best-selling individual plans in 2009 charged a 40-year-old non-smoking woman more than a 40-year-old man who smoked, even in plans that didn’t include any type of maternity coverage. That inequity disappeared when the health law prohibited insurers from charging women higher rates than men for the same services.

“Our concern is going back to a world where insurance companies are writing their own rules again, and returning women to those bad old days in health care and losing all the progress we’ve made,” said Gretchen Borchelt, vice president for reproductive rights and health at the law center.

Several other women’s preventive health services could be on the line if the health law is repealed or changed. Some provisions may be easier to get rid of than others, say women’s health policy experts.

Under the law, procedures recommended by the U.S. Preventive Services Task Force has to be covered without women having to share the cost. The task force, an independent panel of medical experts, evaluates the scientific evidence for screenings, medications and other services and publishes several new or updated recommendations annually. Current recommendations that affect women relate to screening for breast and cervical cancer and testing for the BRCA 1 and 2 genetic mutations that increase women’s risk of breast cancer.

“Coverage of those services can’t be changed without a change to the statute” that created the health law, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms. If the law is repealed, that could happen.

Another group of required preventive services for women could be even easier to eliminate. Under the law, women’s preventive services that are endorsed by the Health Resources and Services Administration have to be covered by most insurers, also without cost sharing. In 2011, the Institute of Medicine proposed a list of eight preventive services that should be covered, and HRSA adopted them.

Among them was the requirement that most insurers cover all FDA-approved contraceptives without charging women anything out-of-pocket. Also included were requirements to cover well-woman visits at least once a year; screening for gestational diabetes; counseling and screening for sexually transmitted infections; breastfeeding support, counseling and supplies; and screening and counseling for domestic violence.

A committee of women’s health providers led by the American College of Obstetricians and Gynecologists has proposed an update to the current guidelines, which is under review by federal officials.

“We expect action will be taken before the end of this administration,” said Palanker.

But the Trump administration may not have the same ideas about which preventive benefits for women should be endorsed. The new secretary of Health And Human Services could make different decisions than the Obama administration.

“What they can endorse they can also unendorse,” said Adam Sonfield, a senior policy manager at the Guttmacher Institute, a research and advocacy organization for reproductive health based in Washington, D.C.

Finally, many of the details about what’s required to comply with the law have been in the form of thousands of pages of regulations and guidance. A new administration could write different rules or just not enforce the ones that are on the books, advocates warn.

Take birth control. Some health plans initially interpreted the requirement to cover FDA-approved contraceptives to mean that if they covered birth control pills, they didn’t have to cover other hormonal methods of contraception such as the vaginal ring or patch. Federal officials under Obama have declared that insurers can’t pick and choose; they have to cover all 18 FDA-approved methods of birth control.

“A lot of the pieces of the preventive services benefits that clarify and make the coverage real and strong has been through [federal officials’] guidance and there is fear that could be changed,” Palanker said.

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