Lewis & Ellis Inc.

Are health insurers doing enough to be ACA compliant?

Health Care and Health Insurance
What options do people have when they lose health insurance?
What options do people have when they lose health insurance?

One part of the Patient Protection and Affordable Care Act that leans more toward the "protection" aspect is that health insurance plans must now come with minimum coverage standards for all consumers, even those buying the least expensive policies. However, a recent study found that, in some instances, this might not always be the case.

In a review of many different coverage options from 15 states in multiple parts of the country, it was found that coverage for women does not comply with minimum ACA standards in a lot of cases, according to a report from the National Women's Law Center. For instance, in seven different states, a total of 14 health insurers don't extend policyholders enough coverage for maternity care (in a variety of ways) to be compliant with the ACA.

But perhaps more worrisome is that in 13 different states, a total of 56 health insurance companies limited access to preventative services that women may need to be healthy, the report said. That included imposing cost-sharing on all women's preventive services, limiting well-woman visits, excluding or limiting coverage for generic testing, not covering supplies for breastfeeding, and cutting access to birth control. Further, another 96 health insurers operating in 12 states also do not meet non-discrimination requirements in the health care law.

Women's health insurance may not give them minimum access to affordable care.Women's health insurance may not give them minimum access to affordable care.

The potential impact
Because these issues can be so widespread, there's some real concern about the amount of access to coverage women will have to the health care they need to be as healthy as possible, the report said. Without certain things being covered, they're likely to end up paying more than they expected to - or should have to - for basic treatments. And that, in the end, might end up causing them to simply go without in the future, despite the risk to their ongoing health. And because this is coming despite the fact that these women actually have health insurance, experts say it's all the more concerning.

What can be done?
Even two years on from when the exchanges opened, there are still a lot of kinks to work out with how insurers make sure their coverage options are compliant with the health care law, the report said. And to that end, experts say it might be important for both state and federal regulators to take a larger role in checking compliance if these problems persist. However, that doesn't just include reviewing policies being offered, but also taking on a larger role in educating women about the kind of care to which they're supposed to have access and ensuring that robust data collection about policies of all types is completed on an ongoing basis.

Meanwhile, health insurers that want to avoid running afoul of regulators as a result of these issues may want to carefully review all their offerings to make sure that they're compliant with the ACA for anyone who might buy them. Whether that's women or men, or people buying expensive plans versus those getting coverage with the lowest price tags, this kind of effort can go a long way.



Consultants to Contact