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Feds Close Insurance Loopholes on Preventive Care

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This image shows the website for updated HealthCare,gov, a federal government website managed by the U.S. Centers for Medicare & Medicaid Service. The Obama administration has unveiled an updated version of HealthCare.gov. It’s got some improvements and some challenges. There’s also at least one early mistake. (AP Photo)

(AP Photo)

Ricardo Alonso-Zaldivar, ASSOCIATED PRESS

 

WASHINGTON (AP) — From contraception to colonoscopies, the Obama administration Monday closed a series of insurance loopholes on coverage of preventive care.

The department of Health and Human Services said insurers must cover at least one birth control option under each of 18 methods approved by the FDA — without copays.

Also, insurers can’t charge patients for anesthesia services in connection with colonoscopies to screen for cancer risk.

President Barack Obama’s health care law requires most insurance plans to cover preventive care at no additional charge to patients. That includes employer plans serving about 3 in 4 workers.

The types of services covered generally dovetail with the recommendations of a government advisory panel. Also on the list are birth control pills and other contraceptives.

But independent experts and women’s groups had recently found coverage gaps for some birth control methods. Insurers said they were trying to comply with the law, but that federal rules did not provide enough detail.

“This has been a problem for women,” said Cindy Pearson, executive director of the National Women’s Health Network. “It seems like some insurers were trying to control costs under cover of medical management.” Her organization advocates on reproductive health and other issues.

Other services covered without copays or cost-sharing include:

— Preventive screening, genetic counseling and BRCA genetic testing for women at increased risk for having a potentially harmful mutation in genes that suppress cancerous tumors.

— Prenatal care and other services to promote healthy pregnancies. The requirement applies to insurance plans that cover children as dependents.

— Certain preventive services for transgender people. For example, a mammogram for a transgender man who has residual breast tissue or an intact cervix.

On birth control, insurers will be required to offer at least one no-cost option in each FDA-approved category. These include daily birth control pills as well as longer-acting hormonal patches and IUDs, and the morning-after pill. The option provided can be a generic, but if a woman’s doctor says a more expensive alternative is medically necessary, the plan must cover it without a copay.

Insurance billing is notorious for breaking down procedures into different subcategories. The new rules made it clear that patients cannot be billed a copay for anesthesia during a colonoscopy.

“The plan or issuer may not impose cost sharing with respect to anesthesia services performed in connection with the preventive colonoscopy if the attending provider determines that anesthesia would be medically appropriate for the individual,” HHS said in its guidance document.

For insurers, the new government requirements take effect in 60 days. In practice, most consumers will not notice major changes until their coverage renews for 2016.
Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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OPINION: California’s Legislature Has the Wrong Prescription for the Affordability Crisis — Gov. Newsom’s Plan Hits the Mark

Last month, Gov. Newsom included measures in his budget that would encourage greater transparency, accountability, and affordability across the prescription drug supply chain. His plan would deliver real relief to struggling Californians. It would also help expose the hidden markups and practices by big drug companies that push the prices of prescription drugs higher and higher. The legislature should follow the Governor’s lead and embrace sensible, fair regulations that will not raise the cost of medications.

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Rev. Dr. Lawrence E. VanHook. Courtesy of Rev. Dr. Lawrence E. VanHook.
Rev. Dr. Lawrence E. VanHook. Courtesy of Rev. Dr. Lawrence E. VanHook.

By Rev. Dr. Lawrence E. VanHook

As a pastor and East Bay resident, I see firsthand how my community struggles with the rising cost of everyday living. A fellow pastor in Oakland recently told me he cuts his pills in half to make them last longer because of the crushing costs of drugs.

Meanwhile, community members are contending with skyrocketing grocery prices and a lack of affordable healthcare options, while businesses are being forced to close their doors.

Our community is hurting. Things have to change.

The most pressing issue that demands our leaders’ attention is rising healthcare costs, and particularly the rising cost of medications. Annual prescription drug costs in California have spiked by nearly 50% since 2018, from $9.1 billion to $13.6 billion.

Last month, Gov. Newsom included measures in his budget that would encourage greater transparency, accountability, and affordability across the prescription drug supply chain. His plan would deliver real relief to struggling Californians. It would also help expose the hidden markups and practices by big drug companies that push the prices of prescription drugs higher and higher. The legislature should follow the Governor’s lead and embrace sensible, fair regulations that will not raise the cost of medications.

Some lawmakers, however, have advanced legislation that would drive up healthcare costs and set communities like mine back further.

I’m particularly concerned with Senate Bill (SB) 41, sponsored by Sen. Scott Wiener (D-San Francisco), a carbon copy of a 2024 bill that I strongly opposed and Gov. Newsom rightly vetoed. This bill would impose significant healthcare costs on patients, small businesses, and working families, while allowing big drug companies to increase their profits.

SB 41 would impose a new $10.05 pharmacy fee for every prescription filled in California. This new fee, which would apply to millions of Californians, is roughly five times higher than the current average of $2.

For example, a Bay Area family with five monthly prescriptions would be forced to shoulder about $500 more in annual health costs. If a small business covers 25 employees, each with four prescription fills per month (the national average), that would add nearly $10,000 per year in health care costs.

This bill would also restrict how health plan sponsors — like employers, unions, state plans, Medicare, and Medicaid — partner with pharmacy benefit managers (PBMs) to negotiate against big drug companies and deliver the lowest possible costs for employees and members. By mandating a flat fee for pharmacy benefit services, this misguided legislation would undercut your health plan’s ability to drive down costs while handing more profits to pharmaceutical manufacturers.

This bill would also endanger patients by eliminating safety requirements for pharmacies that dispense complex and costly specialty medications. Additionally, it would restrict home delivery for prescriptions, a convenient and affordable service that many families rely on.

Instead of repeating the same tired plan laid out in the big pharma-backed playbook, lawmakers should embrace Newsom’s transparency-first approach and prioritize our communities.

Let’s urge our state legislators to reject policies like SB 41 that would make a difficult situation even worse for communities like ours.

About the Author

Rev. Dr. VanHook is the founder and pastor of The Community Church in Oakland and the founder of The Charis House, a re-entry facility for men recovering from alcohol and drug abuse.

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Oak Temple Hill Hosts Interfaith Leaders from Across the Bay Area

Distinguished faith leaders Rev. Ken Chambers, executive director the Interfaith Council of Alameda County (ICAC); Michael Pappas, executive director of the San Francisco Interfaith Council; and Dr. Ejaz Naqzi, president of the Contra Costa County Interfaith Council addressed the group on key issues including homelessness, food insecurity, immigration, and meaningful opportunities to care for individuals and communities in need. 

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Troy McCombs (from the state of Washington), Elder Mark Mortensen (from Irvine, CA), Michael Pappas, Rev. Ken Chambers, Dr. Ejaz Naqvi, Elder Sigfried Nauman (from the state of Washington), and Richard Kopf. Courtesy photo.
Troy McCombs (from the state of Washington), Elder Mark Mortensen (from Irvine, CA), Michael Pappas, Rev. Ken Chambers, Dr. Ejaz Naqvi, Elder Sigfried Nauman (from the state of Washington), and Richard Kopf. Courtesy photo.

Special to the Post

Interfaith leaders from the Bay Area participated in a panel discussion at the annual meeting of communication leaders from The Church of Jesus Christ of Latter-day Saints held on Temple Hill in Oakland on May 31. Distinguished faith leaders Rev. Ken Chambers, executive director the Interfaith Council of Alameda County (ICAC); Michael Pappas, executive director of the San Francisco Interfaith Council; and Dr. Ejaz Naqzi, president of the Contra Costa County Interfaith Council addressed the group on key issues including homelessness, food insecurity, immigration, and meaningful opportunities to care for individuals and communities in need.

Chambers, said he is thankful for the leadership and support of the Church of Jesus Christ Latter-Day Saints’ global ministry, which recently worked with the interfaith congregations of ICAC to help Yasjmine Oeveraas a homeless Norwegian mother and her family find shelter and access to government services.

Oeveraas told the story of how she was assisted by ICAC to the Oakland Post. “I’m a Norwegian citizen who escaped an abusive marriage with nowhere to go. We’ve been homeless in Florida since January 2024. Recently, we came to California for my son’s passport, but my plan to drive for Uber fell through, leaving us homeless again. Through 2-1-1, I was connected to Rev. Ken Chambers, pastor of the West Side Missionary Baptist Church and president of the Interfaith Council of Alameda County, and his car park program, which changed our lives. We spent about a week-and-a-half living in our car before being blessed with a trailer. After four years of uncertainty and 18 months of homelessness, this program has given us stability and hope again.

“Now, both my son and I have the opportunity to continue our education. I’m pursuing cyber analytics, something I couldn’t do while living in the car. My son can also complete his education, which is a huge relief. This program has given us the space to focus and regain our dignity. I am working harder than ever to reach my goals and give back to others in need.”

Richard Kopf, communication director for The Church of Jesus Christ in the Bay Area stated: “As followers of Jesus Christ, we embrace interfaith cooperation and are united in our efforts to show God’s love for all of his children.”

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Activism

“Unnecessary Danger”: Gov. Newsom Blasts Rollback of Emergency Abortion Care Protections

Effective May 29, CMS rescinded guidance that had reinforced the obligation of hospitals to provide abortion services under the Emergency Medical Treatment and Labor Act (EMTALA) when necessary to stabilize a patient’s condition. Newsom warned that the rollback will leave patients vulnerable in states with strict or total abortion bans.

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By Bo Tefu, California Black Media

Gov. Gavin Newsom is criticizing the Centers for Medicare & Medicaid Services (CMS) for rolling back federal protections for emergency abortion care, calling the move an “unnecessary danger” to the lives of pregnant patients in crisis.

Effective May 29, CMS rescinded guidance that had reinforced the obligation of hospitals to provide abortion services under the Emergency Medical Treatment and Labor Act (EMTALA) when necessary to stabilize a patient’s condition.

Newsom warned that the rollback will leave patients vulnerable in states with strict or total abortion bans.

“Today’s decision will endanger lives and lead to emergency room deaths, full stop,” Newsom said in a statement. “Doctors must be empowered to save the lives of their patients, not hem and haw over political red lines when the clock is ticking. In California, we will always protect the right of physicians to do what’s best for their patients and for women to make the reproductive decisions that are best for their families.”

The CMS guidance originally followed the 2022 Dobbs decision, asserting that federal law could preempt state abortion bans in emergency care settings. However, legal challenges from anti-abortion states created uncertainty, and the Trump administration’s dismissal of a key lawsuit against Idaho in March removed federal enforcement in those states.

While the rollback does not change California law, Newsom said it could discourage hospitals and physicians in other states from providing emergency care. States like Idaho, Mississippi, and Oklahoma do not allow abortion as a stabilizing treatment unless a patient’s life is already at risk.

California has taken several steps to expand reproductive protections, including the launch of Abortion.CA.Gov and leadership in the Reproductive Freedom Alliance, a coalition of 23 governors supporting access to abortion care.

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