Women's preventive health benefits

New changes effective on August 1, 2012

As you may know, the Affordable Care Act (ACA, or Health Care Reform law) includes changes that are being phased in over a number of years. The latest set of changes includes additional benefits for certain Women's Preventive Health Services.  

When plans renew or are effective on or after August 1, 2012, all of the following women's health services will be considered preventive (some are possibly already covered).  

These services generally will be covered at no cost share, when provided in-network:

• Well-woman visits (annually and now including prenatal visits)
• Screening for gestational diabetes
• Human papillomavirus (HPV) DNA testing
• Counseling for sexually transmitted infections
• Counseling and screening for human immunodeficiency virus (HIV)
• Screening and counseling for interpersonal and domestic violence
• Breastfeeding support, supplies and counseling
• Generic formulary contraceptives, certain brand formulary contraceptives, and FDA-approved, over-the-counter female contraceptives with prescription are covered without member cost share (for example, no copayment). Certain religious organizations or religious employers may be exempt from offering contraceptive services.

Supreme Court Upholds Healthcare Law

The U.S Supreme Court upheld the individual mandate that is the centerpiece of President Obama's healthcare reform law.

The court has upheld most of the Patient Protection and Affordable Care Act but did find the Medicaid expansion provision opposed by a number of states violates the Constitution.

In the key issue, the Supreme Court was asked to decide if the individual mandate requiring citizens to obtain health insurance or pay a penalty by 2014 violates the Constitution. The court majority said it is a valid provision under the federal government's taxing powers, although not under the Commerce clause.

Chief Justice John Roberts issued the ruling and cast a vote with the liberal justices in favor of the mandate as a valid tax.

The Roberts opinion said the government cannot force citizens to buy health insurance but can impose a tax on those who do not have insurance. It said it is not the court's role to decide the wisdom of the tax.

"The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to con­strue what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Con­gress's power to tax," Roberts wrote in the 5-4 decision.

Roberts also wrote, "The Affordable Care Act's requirement that certain in­dividuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Be­cause the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness."

The court's four  liberal members - Justices Ruth Bader Ginsburg, Stephen Breyer, Elena Kagan and Sonia Sotomayor - sided with Roberts in upholding the law's key individual mandate provision.

Four conservatives - Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito - dissented, finding that the mandate and the entire law should be invalidated.

President Obama addressed the public on the opinion at 12:45 p.m., claiming the decision is a victory for Americans.

Republican House leaders and GOP presidential candidate Mitt Romney have vowed to repeal the law. Romney  said the law remains "bad" public policy that should be repealed despite the court upolding it.

Read the 193-page opinion here.

View this article online:  

http://www.insurancejournal.com/news/national/2012/06/28/253440.htm 

Obama & Romney  

Reactions to the Health Care Ruling