Delegation urges feds to step up enforcement of insurers’ compliance with ACA contraceptive mandate

Delegation’s Letter Highlights Vermont’s Recent Investigation into Three Major Insurers’ Failure to Comply with Affordable Care Act Contraceptive Mandate Impacting Thousands of Vermonters

Vermont Business Magazine Senator Bernie Sanders (I-Vermont), Senator Peter Welch (D-Vermont), and Representative Becca Balint (D-Vermont) have called on US Department of Health and Human Services Secretary Xavier Becerra, US Department of Labor Acting Secretary Julie Su, and US Department of Treasury Secretary Janet Yellen to detail steps they are taking to strengthen federal enforcement of Affordable Care Act (ACA) to provide no-cost contraceptive coverage in order to keep contraception affordable and accessible to consumers. 

The letter, sent on November 17, highlighted a recent investigation by the Vermont Department of Financial Regulation that found three insurers in Vermont—Blue Cross Blue Shield Vermont, MVP Health Care, and Cigna Healthcare—had failed to provide patients with no-cost contraceptive services, in violation of state and federal law. 

“It’s more important than ever to ensure proper access and no-cost coverage for contraceptive services. We applaud the State of Vermont’s effort to make sure that insurers are complying with the Affordable Care Act and state contraceptive coverage mandates,” said the Delegation in a statement. “However, Vermont doesn’t regulate all insurance types, so further federal action is required to improve nationwide insurer compliance with ACA contraceptive mandates. It’s time for the federal government to follow Vermont’s lead and prioritize enforcement and compliance with federal law.”   

The DFR investigation found that patients were inappropriately charged a cumulative $1.5 million in contraceptive costs between 2017 and 2021. The investigation resulted in restitution for 9,000 people for whom cost sharing was incorrectly applied for contraceptive services. 

An October 2022 investigation by the U.S. House of Representatives’ Oversight Committee also found that insurers nationally are not complying with ACA requirements for contraceptive coverage. The Committee found that health plans and pharmacy benefit managers exclude or impose cost-sharing on at least thirty-four contraceptive products. 

A majority of the insurance companies surveyed by the Committee denied an average of 40% or more of exception requests for contraceptive products between 2015 and 2021, with one company denying more than 80% of requests each year. 

Read the full text of the letter here

Source: 11.17.2023. WASHINGTON, D.C. – Delegation

Vermont Business Magazine