Since last August, I've been counting down the days until my 30th birthday this Wednesday. You see, I've got money coming my way—not just in the form of birthday checks from my grandmother and aunts—but an even larger chunk of change, spread out over the entire year. Starting August 1, I, along with millions of women in the U.S., are going to start saving hundreds of dollars annually now that a new Affordable Care Act (ACA) provision will begin removing insurance co-pays for reproductive preventive services for women. For the year to come, I'm expecting to keep at least $395 a year in "cost-sharing" co-pays that I will no longer be paying.
"While women are more likely to need preventive health care services, they often have less ability to pay," an official at the U.S. Department of Health and Human Services (HHS) explained to me in a recent email. "Removing cost sharing requirements lets women decide which preventive services they'll use and when."
Starting this Wednesday, the ACA requires private insurance companies to offer free:
- approved contraceptives (per the U.S. Food and Drug Administration's recommended list, which includes major oral contraceptives as well as sterilization procedures) as well as contraceptive counseling;
- well-woman visits (those annual trips in to the OB/GYN to get everything checked out);
- breastfeeding supplies (such as breast pumps), support and counseling;
- STI (sexually transmitted infection) counseling—including HIV testing and counseling as well as genetic HPV (human papillomaviurs) testing for women 30 and older;
- screening for gestational diabetes (a condition which can increase the risk for complications and developing type 2 diabetes later as well as metabolic challenges for the child); and
- domestic violence screening and counseling.
"These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need," Kathleen Sebelius, U.S. Department of Health and Human Services secretary, said in a prepared statement last August announcing the new provisions. The HHS selected these guidelines upon recommendations made in a July 2011 report from the Institute of Medicine.
The aim of the new changes is to close some of the screening and preventive measures that were not covered for women under previous changes that went into effect in September 2010 (which included free blood pressure and cholesterol screening for both men and women). Earlier provisions in the ACA have already mandated other free preventive services for women, including mammograms and cervical cancer screening.
I count myself among the fortunate majority (about 64 percent of the U.S. population) who has private health insurance. I have only had to pay out of pocket for co-pays for birth control and well-woman visits. The new requirements will not make these additional services free to women who are not on private insurance, but depending on income, many women might already have access to free preventive health services through other means.
The small co-pays once a month at the pharmacy and once a year at the doctor's office might not seem like much—$30 here and $35 there—but a 2009 report from the Commonwealth Fund found that more than half of women reported either skipping or putting off preventive care because of cost. "The inability of patients to access preventive care contributes to the nation's escalating health care costs, hurts people's health and lowers productivity," the HHS official notes.
Not to mention that with the recent U.S. Centers for Disease Control and Prevention finding that one third of births in the U.S. are still a result of unplanned pregnancies, fewer barriers to family planning—and to preventive healthcare once women decide they want to get pregnant—should be a boost for everyone.
The new provision allows insurance companies to manage costs by, for example, continuing to charge co-pays for name-brand birth control pills if the generics are offered to their policyholders at no cost. And many plans will not be required to incorporate the changes until the new "policy year" starts, on January 1, 2013—although some are choosing to start them right away.
It's hard to say exactly where the extra money for getting rid of these co-pays will come from. "Any time benefits are added to a policy, the additional costs are reflected in the cost of health care coverage," Robert Zirkelbach, a spokes person for America's Health Insurance Plans, a trade group that represents insurance companies, wrote to me in an email. But he declined to speculate about how any particular companies factor in the costs of this new coverage to the bottom line. Fewer unplanned pregnancies, less severe complications due to gestational diabetes and more kids and moms who are healthier as a result of breastfeeding, however, should reduce reimbursements for insurance companies for many decades to come.
Health insurance companies already "encourage policyholders to get recommended preventive care," Zirkelbach says. For good reason—it saves them a lot of money.
But despite previous "encouragement," removing financial hurdles—even seemingly small ones—should increase the use of these services even further. As the HHS official noted, "Reducing cost sharing increases use of preventive services."
So for my birthday, I'll appreciate the extra money in my pocket for the coming year, but I'll be even happier to know that these newly accessible services should make planning and raising healthy families easier for both women and men.