Published July 1, 2014
Providing essential health care benefits remains a fundamental tenet of the Affordable Care Act, despite a Supreme Court ruling that some employers do not have to comply with the law’s birth control mandate, says University at Buffalo medical policy expert Nancy H. Nielsen, MD, PhD, senior associate dean for health policy.
According to the court’s 5-4 decision, closely held for-profit companies may refuse to cover certain birth control methods if they conflict with the owner’s religious beliefs.
“The justices went out of their way to say their Burwell v. Hobby Lobby Stores decision doesn’t extend to other health insurance mandates, like blood transfusions and vaccinations,” says Nielsen, “so I don’t think this will have bigger implications beyond the contraception issue.”
Nonetheless, she predicts “the number of employers opting out of contraception coverage will probably grow.”
“This case was a challenge to part of the health care law that requires coverage for specified essential preventive services — including contraception — without copays or deductibles,” says Nielsen, past president of the American Medical Association.
The provision applies only to insurance plans that emerged or changed significantly since 2010; it does not affect “grandfathered” plans in place prior to the act’s passage, unless major changes were made to benefits or copays, Nielsen notes.
The U.S. Department of Health and Human Services determined the list of essential benefits, based on criteria from an Institute of Medicine advisory panel.