Senator Hassan, Colleagues are Calling for Enforcement of Law that Requires Birth Control to be Covered Under the Affordable Care Act
WASHINGTON – U.S. Senator Maggie Hassan, a member of the Health, Education, Labor, and Pensions Committee, is leading a group of 33 of her colleagues in calling on the Biden administration to improve enforcement of the federal law that guarantees complete coverage of birth control for women who get their health insurance through the Affordable Care Act (ACA). Despite existing law, certain health insurers continue not to cover all birth control methods and deny women coverage for birth control even when their doctor recommends it.
“In New Hampshire and across the country, women’s reproductive health care is under attack,” Senator Hassan said. “These attacks undermine a woman’s ability to participate fully in our economy and control their own destiny – and my push to ensure that women have access to contraception is one piece of our efforts to protect women’s health. From the New Hampshire State House to health insurance companies, I will continue to stand up to those who are working to restrict a woman’s reproductive freedoms.”
In their letter to the administration, the Senators wrote, “At the federal level, the Affordable Care Act (ACA) guaranteed women access to birth control with no out-of-pocket costs. The evidence for the public health benefits of this requirement is clear. Yet since the ACA’s passage, certain insurers have not complied with this provision.”
The Senators continued, “The Department of Labor (DOL) recently released FAQs acknowledging the reports that some plans continue to deny coverage for birth control and fail to maintain an exceptions policy that allows women to access the best birth control method for their individual health needs. This notice was a good start. We are writing to request that the DOL and the Department of Health and Human Services (HHS) issue specific updated guidance and take the proposed enforcement measures to ensure that plans fully comply with birth control coverage requirements.”
Senator Hassan’s advocacy comes as women across the country are sharing their stories about their insurers denying them birth control. For example, one woman was denied coverage for a NuvaRing after her insurer told her that the process to get alternative birth control covered by insurance did not exist – which is false. Other woman have shared similar stories of their insurers telling them that an exception process for birth control does not exist, despite language in the law that clearly states that women are guaranteed complete health care coverage for birth control, including alternative birth control if its judged to be medically necessary by a medical provider. You can read more of these stories here.
The Senators’ efforts are supported by national and local organizations.
“Senator Hassan works tirelessly to ensure everyone has affordable access to contraception, including her efforts to strengthen the Affordable Care Act’s successful no out-of-pocket costs for birth control provision,” said Kayla Montgomery, VP of Public Affairs, Planned Parenthood of Northern New England. “The public health benefits of this coverage is clear. Studies show that when cost is removed as a barrier to an individual’s birth control method of choice, people use contraception more consistently, which helps prevent unintended pregnancy and plan families. As out-of-touch politicians in Washington and New Hampshire try to limit access to reproductive health care, we’re grateful for Senator Hassan’s unwavering support.”
“At the National Women’s Law Center, we hear from people every day on our CoverHer hotline who cannot access the birth control, guaranteed to them by the law, without out-of-pocket costs,” said Fatima Goss Graves, President & CEO, National Women’s Law Center. “Health plans charging for birth control is illegal under the ACA and is particularly harmful to those who already face barriers to health care including Black women, Latina women, and LGBTQ individuals. The Biden administration has taken action to remove barriers to accessing birth control but more is needed. We need strong enforcement of the law and further guidance on implementation so that everyone across the country is able to access the care they need.”
“The Affordable Care Act’s birth control benefit is essential to ensuring that everybody in our country can access the contraceptive method that is best for them,” said NARAL Pro-Choice America President Mini Timmaraju. “Everybody should have the freedom to make their own decisions about whether and when to start or grow a family. In this pivotal moment for reproductive freedom, we must continue to do all that we can to realize a future where we all have the ability to chart our own destinies."
In addition to Senator Maggie Hassan (D-NH), the letter is signed by Senators Jeanne Shaheen (D-NH), Elizabeth Warren (D-MA), Sherrod Brown (D-OH), Ed Markey (D-MA), Tammy Duckworth (D-IL), Chris Van Hollen (D-MD), Richard Blumenthal (D-CT), Angus King (I-ME), Tammy Baldwin (D-WI),Tina Smith (D-MN), Amy Klobuchar (D-MN), Bernie Sanders (I-VT), Chuck Schumer (D-NY), Martin Heinrich (D-NM), Dianne Feinstein (D-CA), Catherine Cortez Masto (D-NV), Kirsten Gillibrand (D-NY), Ben Cardin (D-MD), Cory Booker (D-NJ), Jacky Rosen (D-NV), Jack Reed (D-RI), Alex Padilla (D-CA), Chris Murphy (D-CT), Debbie Stabenow (D-MI), Tim Kaine (D-VA), Bob Menendez (D-NJ), Jeff Merkley (D-OR), Mark Kelly (D-AZ), Ben Ray Lujan (D-NM), Michael Bennet (D-CO), John Hickenlooper (D-CO), Chris Coons (D-DE), and Gary Peters (D-MI).
Senator Hassan is focused on expanding access to reproductive health care services. Following efforts by Senator Hassan and others, the Biden administration reversed the Title X Gag Rule implemented by the last administration that cut off federal funding to the majority of New Hampshire’s family planning centers. Shortly after this announcement, Senator Hassan and the rest of the NH delegation called on the administration to swiftly release Title X funding to New Hampshire following the NH Executive Council’s repeated votes to defund family planning centers in the state. Following those calls, the Biden administration announced $500,000 to Planned Parenthood of Northern New England through a Title X Dire Need Grant award.
To read the Senators’ letter click here or see below:
Dear Secretary Becerra, Secretary Walsh, and Secretary Yellen,
People across the country are watching as politicians and judges roll back reproductive health protections, compromising their ability to make their own health care decisions and control their destinies. At the federal level, the Affordable Care Act (ACA) guarantees individuals access to birth control with no out-of-pocket costs. The evidence for the public health benefits of this requirement is clear. Yet since the ACA’s passage, certain insurers have not complied with this provision.
The Department of Labor (DOL) recently released FAQs acknowledging the reports that some plans continue to deny coverage for birth control and fail to maintain an exceptions policy that allows patients to access the best birth control method for their individual health needs.  This notice was a good start. We are writing to request that the DOL, Department of Health and Human Services (HHS), and Department of Treasury (Treasury) issue specific updated guidance and take the proposed enforcement measures necessary to ensure that plans fully comply with birth control coverage requirements.
Under the ACA, health insurers must ensure that people have access to the full range of birth control approved by the Food and Drug Administration without co-payments, deductibles, or coinsurance. Under the current requirements, insurers may use limited reasonable medical management techniques to determine coverage. However, they must maintain an exceptions policy so that an enrollee can obtain a medically necessary form of birth control at no cost, even if the plan does not normally cover it. We appreciate that the Departments reiterated that this exceptions policy must be “easily accessible, transparent, and sufficiently expedient,” and it “must defer to the determination of the attending provider.”
As noted in the recent DOL FAQs, some health insurers reportedly engage in practices that violate the ACA’s protections for birth control access. According to these reports, these insurance companies overrule provider recommendations without explanation, incorrectly state that no exceptions policy exists, and fail to provide an exceptions policy entirely. Ultimately, these actions make it harder for people to access medically necessary birth control and force them to pay out-of-pocket for services that they are legally entitled to receive cost-free.
We were heartened to see DOL acknowledge its responsibility to examine the reports of coverage denials. We encourage DOL, HHS, and Treasury to take steps to oversee plan compliance, including engaging in enforcement action against non-compliant plans. We also urge the Departments to issue additional guidance or rules compelling plans to establish a clear exceptions policy, including a standard form for medical providers to request a coverage exception. This guidance could also direct plans to include information on their exceptions policy in enrollee materials, such as plan documents, formularies, and websites. Additionally, to ensure that plans comply with the ACA’s birth control coverage requirement, the administration can evaluate plans for the presence and execution of their exceptions policies.
DOL’s recent action was an essential first move. We look forward to seeing more from HHS, DOL, and Treasury as they respond to these reported violations and hold non-compliant insurers accountable, ensuring that exceptions policies are put in place. We ask that you respond to this letter by March 30 with a plan and timeline for issuing new guidance and developing enforcement procedures.
At this critical moment for reproductive freedom, we look forward to working with the administration to ensure that everyone can access to the reproductive rights they have been promised.
 U.S. Department of Labor. “FAQs About Affordable Care Act Implementation Part 51, Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation.” January 10, 2022. https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf.
 U.S. Department of Labor. “FAQs About Affordable Care Act Implementation (Part XXVI).” May 11, 2015. www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-xxvi.pdf.
 National Women’s Law Center. “Access to Birth Control Without Out-of-Pocket Costs: Improving and Expanding the Affordable Care Act Contraceptive Coverage Requirement.” November 2021. https://nwlc.org/wp-content/uploads/2021/11/final_Long_nwlc_2021_BC_AffordCareAct-003.pdf; National Women’s Law Center. “The Biden Administration Must Ensure the Affordable Care Act Contraceptive Coverage Requirement Is Working for All.” October 2021. https://nwlc.org/wp-content/uploads/2021/10/NWLC_BC_AffordCareAct-Oct_2021.pdf; National Women’s Law Center. “Exception Policies: Advocating for No-Cost Coverage of Noncovered Contraceptives.” March 2021. https://nwlc.org/wp-content/uploads/2021/03/Exceptions-Guide.pdf; National Women’s Law Center. “CoverHer Impact Report.” 2018. https://nwlc.org/wp-content/uploads/2018/04/CoverHer-Impact-Report-April-2018-FINAL.pdf; National Women’s Law Center. “The Affordable Care Act’s Birth Control Benefit: Progress on Implementation and Continuing Challenges.” July 2016. https://nwlc.org/wp-content/uploads/2016/07/The-ACAs-BC-Benefit-Report.pdf.