Want an IUD? Take note of Trump’s new birth control policy.

Oct 17 2017

The Trump administration's recently announced changes to health insurance rules have raised concerns among people wondering how they'll be affected. This week, I address some of the questions likely on people's minds.

Q: IUDS are expensive. Will they be unaffordable under the new contraceptive rules announced by the Trump administration? Should people make an appointment to get one now before employers change their minds about coverage?  

There's probably no need to rush out to your doctor's office to get an IUD, but you should keep an eye on this issue.

Under the Affordable Care Act, most health plans are required to cover all methods of birth control approved by the Food and Drug Administration without charging women anything for them. Religious employers and some private employers with strong religious objections are exempt from the requirement, but it's a pretty limited group. Or it was until the Trump administration issued new rules during the first week of October that open the door for many companies or nonprofit organizations with religious or moral objections to contraception to stop offering it.

"These new exemptions are sweeping," said Adam Sonfield, a senior policy manager at the Guttmacher Institute, a reproductive health research organization. Essentially any employer will be able to claim an exemption from the birth control coverage requirement, he said, and there are no provisions to appeal it.

What's not at all clear, however, is how many employers will take advantage of the new rules. The administration said it expected the number to be small, probably just the companies that had brought suit against the old rules.

Even before the ACA passed, women's health experts note, many plans covered contraception. They didn't necessarily cover all FDA-approved methods, however, and women typically had to pay a share of the cost.

Several states have laws that protect birth control coverage, said Mara Gandal-Powers, senior counsel at the National Women's Law Center. Some require that if a plan offers prescription drug coverage, for example, it must cover contraceptives. Others have adopted the ACA rules that require coverage of all FDA-approved methods without cost sharing. But those laws would not apply to employers that pay their employees' health care claims directly rather than buy state-regulated insurance.

The protection from cost sharing is key, experts say, especially for highly effective methods like the IUD, which might cost $1,000 upfront.

"Even if you've met your deductible, if you have 20 percent coinsurance, that’s $200, and for many people that's not feasible," Gandal-Powers said.

If your employer does decide to stop providing insurance coverage for contraception, in most cases plans have to give workers 60 days' notice of the benefit change, giving you time to get that IUD if you decide to.

Q: Association health plans, which the Trump administration is encouraging, seem like kind of a good idea. If more small companies band together, won't that make coverage cheaper?

President Donald Trump signed an executive order last week that directs several federal agencies to consider proposing rules that, among other things, would allow more employers to buy health insurance through associations.

If you're young and healthy, getting coverage through an association health plan might indeed be cheaper. But you'll likely forgo consumer protections that are required for plans sold on the individual and small-group markets, said Kevin Lucia, a research professor at Georgetown University's Center on Health Insurance Reforms.

Plans currently sold in those markets have to cover 10 so-called essential health benefits. Association health plans would likely sidestep that requirement. (However, implementing federal rules for these plans will take the administration some time, so it's not clear if or when they might be expanded.)

"If you don't cover maternity, mental health or hospitalization, the premiums are going to be lower," Lucia said.

The administration's press release about the executive order said that employers couldn't exclude any employees from joining association health plans or "develop premiums based on health conditions."

But association health plans have been known to use many strategies to cherry-pick employers with healthy workforces, Lucia said.

"The risk is that each individual small-employer's rates would be separately determined based on its employees' medical claims, potentially splitting the market into employers with sicker workers and those whose workers are healthier," he said.

Q: Short-term plans are cheaper than Obamacare plans. If people don't have preexisting conditions and are willing to pay the penalty under the law for not having minimum coverage, what's the downside?

Trump's executive order that encouraged the expansion of association health plans, discussed above, also aims to expand the availability of short-term plans. Under Obama administration rules, the coverage period of short-term plans was limited to less than three months. This executive order proposes to expand that, perhaps to just under a year.

In addition to not covering preexisting conditions, short-term plans often exclude certain types of coverage, such as prescription drugs and maternity care, and impose dollar limits on coverage. The maximum out-of-pocket spending limits are often higher than coverage in a marketplace plan too.

The potential downside is the possibility that you may develop a medical condition or have an accident that requires expensive medical care while you're covered under this plan, experts say.

"If the reader has a car accident, the insurer wouldn't renew the policy," said Timothy Jost, an emeritus professor of law at Washington and Lee University in Virginia who is an expert on health law. "If coverage is terminated, you're not eligible for a special enrollment period [on the exchange]. So you could just get marooned."

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