Health insurance law not the same for all plans when it comes to contraception


As the state Legislature fast-tracks a bill to ensure broader birth control coverage in light of the federal reversal of this requirement, many Massachusetts residents will still be legally vulnerable to losing coverage.

But that doesn't mean it's likely.

The House passed a bill — H 4009, known as the ACCESS bill — Wednesday. If enacted, it would guarantee no-cost coverage of contraception for some people.

About one-third of the state's total population is covered through plans provided by the employer in a structure known as a self-insured plan. In self-insured plans, a company acts as the insurer on behalf of its employees. The company takes on the financial risk, sometimes using an outside insurance company simply to administer benefits.

This is opposed to a fully insured structure, in which employers contract with a payer to take on this risk.

But most people don't know this. Because workers get their coverage through their employers in both circumstances, it is difficult to know the difference unless an employee asks.

Many larger companies use the self-insured structure.

Self-insured plans are governed by the federal government, not state law. This leaves anyone receiving coverage under those plans vulnerable to losing no-cost contraception under the federal government's reversal of this requirement last month.

But many people involved in crafting H 4009 think that's unlikely to happen.

"Of course we are concerned about the self-insured market," said Rebecca Hart Holder, executive director of NARAL Pro-Choice Massachusetts. "[But] I don't suspect that [a majority] of the market will suddenly lose coverage."

Insurance companies understand the importance of covering contraception, said state Rep. Tricia Farley-Bouvier, D-Pittsfield. "I don't know any insurer in our state who would not cover birth control."

The Massachusetts Association of Health Plans' 17 member organizations, which include Harvard Pilgrim Health Care and Tufts Health Plan, all collectively agreed to compromise language of H 4009, said Lora Pellegrini, president of the Massachusetts Association of Health Plans.

The ACCESS bill gained momentum after the Trump administration released two regulations, known as interim final rules, last month through the Department of Health and Human Services.

The rules expand opt-out justifications to contraceptive coverage requirements for insurers and employers. A broad array of employers and insurers, including at least some for-profit companies, can now claim moral or religious objections to covering contraception.

It didn't surprise Farley-Bouvier that the ACCESS bill passed easily through the House on Wednesday.

But it passed without further amendments — something that did surprise her.

"It went pretty smoothly," she said. "There's a poetic nature to all of this, in that [Wednesday] was the one-year anniversary of Trump being elected."

Patricia LeBoeuf can be reach at, @BE_pleboeuf on Twitter and 413-496-6247.


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