For most Americans, the landmark Affordable Care Act is still more a news story and a court case than a reality. But that’s going to start changing for tens of thousands of Capital Region women, as private health insurance companies begin phasing in a major benefit of the new law.
As of Aug. 1, private insurers must eliminate co-pays and deductibles for a range of preventive health services for women. Co-pays can add as much as $30 to a doctor’s visit.
Although lower-cost access to birth control has been the most frequently mentioned result of this change, the new law covers many other important health services that could help save lives, said Brian O’Grady, vice president of BlueShield of Northeastern New York. Among those services: screening for gestational diabetes, HIV, the human papillomavirus and domestic violence.
“Any time that we can make screenings for prevention and early detection more accessible, that’s always a good thing,” O’Grady said. “The one that seems to be catching the most attention is birth control, but this covers a wide range of services.”
When asked if he expects the more affordable access to care to in turn lower insurer’s costs—it is, after all, far less expensive to pay for birth control than a pregnancy—O’Grady replied, “Time will tell.”
Women should remember that they may have to provide co-pays and deductibles for the time being, as the law allows insurers to phase in the change, and companies can also choose to apply the exemption to only generic brands of birth control. Insurers that choose to phase in the exemption will probably do so during quarterly renewal periods for clients.
“I think that the biggest message that we’re trying to get out is this is going to benefit a lot of people, but there’s a lot of confusion,” said Blue Carreker, a spokeswoman for Upper Hudson Planned Parenthood. Planned Parenthood is urging women to call the member benefits department of their insurance company for information, because the application of the exemption varies so greatly. Women on Medicaid already do not provide co-pays for their care.
Carreker predicted that it will take as long as two years for all eligible women in the region to benefit from the exemption, but she said that insurers so far are responding positively to the change.
In a written response to questions, Michael Traphagan, a spokesman at MVP Health Care, said it’s way too early to do a cost analysis of the change. He also said that private insurance companies will not suffer a financial loss from the exemptions for co-pays.
“When mandates like this one remove an out-of-pocket cost for the consumer, the cost of the service does not change,” Traphagan said in his response. “Instead of being funded by co-pays, the cost of these drugs will instead be funded by an increase in the premiums paid by all members.”
“As the cost of health care continues to rise,” Traphagan adds, “making the cost of health insurance an increasing burden, especially for families and small businesses, we as a society need to find an appropriate balance between the competing priorities of providing access to comprehensive coverage and making health insurance as affordable as possible.”
Still, as Dr. John Bennett, president and CEO of Capital District Physicians’ Health Plan, said in a statement when the change went into effect, chronic diseases are responsible for 7 out of 10 deaths in the country and account for 75 percent of health care costs. The hope is that the new exemption for co-pays will save money by catching costly and deadly diseases sooner.
Bennett said, “Studies have shown that women delay or avoid critical screenings when costs are involved.”
Reached for comment, Assembly health committee chairman Richard N. Gottfried (D-Manhattan) underlined how provisions of Obamacare would benefit the working poor and middle-class women: “As provisions of the Affordable Care Act continue to roll out for implementation, people around the country will see clearly how important these reforms are for their health and family finances. The provisions related to women’s preventative health services are of particular importance and begin to breakdown the financial barriers that can impede access to care.”