By: Karen Davenport, Director of Health PolicyPosted on April 30, 2015 Issues: Health Care

Yesterday, the National Women’s Law Center issued an extensive report on insurance issuers’ compliance with Affordable Care Act requirements for women’s health coverage. We found violations in health plans offered in all 15 states in our study — which tells us that women covered by other issuers, and in other states, are probably also being denied coverage for the critical women’s health services guaranteed by the law.

The ACA made dramatic improvements in women’s health coverage by ensuring that health insurance companies can no longer discriminate against women, and requiring plans to offer women coverage for critical health services like maternity care, birth control and prescription drugs. But these guarantees ring hollow when insurance issuers are able to offer coverage that violates these requirements.

We reviewed plan documents from more than 120 issuers, looking at the Qualified Health Plans they offer on the health insurance marketplaces in 15 states – Alabama, California, Colorado, Connecticut, Florida, Maine, Maryland, Minnesota, Nevada, Ohio, Rhode Island, South Dakota, Tennessee, Washington State and Wisconsin.

We found serious problems, such as:

  • 14 issuers in seven states who offer maternity coverage that does not comply with the law, such as insurance companies that do not cover maternity care for dependents.
  • Issuers who do not comply with the ACA’s requirements for preventive services, such as imposing impermissible limits on coverage of breastfeeding supports and supplies, limiting coverage for well-woman visits, and failing to offer birth control supplies, services and counseling as required by law.
  • 96 issuers across 12 states who do not comply with the ACA’s non-discrimination requirements by restricting coverage based on age, excluding care for transgender individuals, or excluding coverage of chronic pain treatment.

Altogether, more than half of the issuers we examined offer coverage that violates the ACA. These violations mean that women in these plans may pay more than they should for covered services, may be without coverage for health needs that issuers are required to cover by law, and may end up going without the care they need, even though they have health insurance.

We know that insurance companies can do better. And to make sure they do, we will be working with state health advocates and other stakeholders to urge state and federal regulators to provide stronger oversight to ensure plans comply with the law, make these documents publically available in all states, collect data on plan violations to inform future policymaking, and inform women about their rights to coverage and what they can do if their plan violates the law. 

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