In a Monday letter, Senator Bernie Sanders (D-Vermont) asked the Government Accountability Office (GAO) to look into some payers’ coverage of contraceptives. The GAO is a nonpartisan agency that works for Congress and investigates how taxpayer dollars are spent.
Under the Affordable Care Act, which was signed into law in 2010, most private health insurance plans are required to cover the “full range of birth control methods approved by the U.S. Food and Drug Administration” without out-of-pocket costs, the letter states. But not all plans are doing this, Sanders declared.
“While this important legislation prohibited cost-sharing, co-payments, and deductibles for contraception, the law can only help patients if it is both followed and enforced,” Sanders said. “This is critical given the evidence that any cost-sharing can be a barrier to patient access.”
He called out three insurers specifically: Blue Cross Blue Shield Vermont, MVP Health Care and Cigna Healthcare. A State of Vermont Department of Financial Regulation investigation found that the insurers “violated state and federal law by neglecting to provide no-cost contraceptive services to consumers.” Between 2017 and 2021, these insurers wrongly charged patients $1.5 million for contraceptives that should have had no out-of-pocket costs. Because of this, 9,000 people received restitution.
Blue Cross Blue Shield Vermont and Cigna Healthcare did not return requests for comment. Jordan Estey, senior director of government affairs at MVP Health Care, said the organization “shares Sen. Sanders’ concerns about cost-sharing barriers and the importance of no-cost access to contraceptive coverage and services.”
“We are deeply committed to compliance with both Vermont and federal laws concerning reproductive rights and vital preventive services for our customers,” Estey told MedCity News. “In 2021, MVP worked collaboratively with Vermont regulators to identify coding errors, claims processing limitations, and differing statutory interpretations related to Vermont state laws which go beyond the ACA contraceptive mandate. MVP’s systems have since been updated to rectify the administrative processing errors and affected members were informed on how to seek restitution, including with interest, for any incurred costs due to the errors.”
Sanders also cited a 2022 investigation by the House Oversight Committee, which discovered that insurers across the country are not complying with ACA requirements for covering contraceptives. Health plans and pharmacy benefit managers “exclude or impose” cost-sharing on at least 34 birth control products, the investigation found. In addition, between 2015 and 2021, most insurance companies surveyed denied 40% or more of exception requests for contraceptives. One company denied more than 80% of requests each year.
“The ACA has been federal law for 14 years and we continue to see plans deny coverage and ignore the federal mandate. It is completely unacceptable that plans consistently defy mandated coverage and that there is little enforcement or accountability,” Sanders said.
Sanders specifically asked GAO to consider these three questions:
- How do states and federal agencies monitor group and individual health plans to ensure they comply with the ACA requirement that contraceptives must be covered without cost-sharing for patients?
- How do the Departments of Health and Human Services, Labor and Treasury supervise adherence to the ACA mandate, and what challenges do these agencies encounter in enforcing and overseeing compliance?
- To what extent do group and individual health plans comply with the ACA mandate for contraceptive coverage?
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