Each insurer marketing a health plan in an exchange can determine whether or not its plan will cover abortion and, if it does, whether coverage will be limited to or go beyond those allowed under the Hyde Amendment. No federal tax or premium subsidies may be used to pay for abortions beyond those permitted by the Hyde Amendment.
The Secretary of HHS must ensure that at least one plan in each state exchange covers abortion, and that at least one plan either covers no abortions or limits abortions to those allowed under the Hyde Amendment. Insurers who offer abortion coverage beyond Hyde have to comply with a number of administrative requirements.
Congress was clear that the ultimate decisions about abortion should be made at the state rather than the federal level, and it gave states the ultimate trump card: Any state can pass legislation that prohibits any plan from offering abortion coverage of any kind within that state’s exchange. Any state can prohibit insurers offering plans within that state’s exchange from including any abortion coverage.
10 additional health provisions under the ACA
1. Creation of women's medical homes
The law points the way for creation of medical homes for women in the Medicare and Medicaid programs. The bill establishes an Innovation Center within the Centers for Medicare and Medicaid Services that has broad authority to evaluate, test, and adopt systems that foster patient-centered care, improve quality, and contain costs under Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP)—and this includes patient-centered medical homes that address women’s unique health needs. ObGyn practices are eligible to participate and to receive additional reimbursement if they do.
2. Smoking-cessation counseling in pregnancy
The framers of the ACA recognized the large negative impact that smoking has on health, especially during pregnancy. Studies suggest that the intervention of a physician—most notably, counseling of the patient to quit smoking—has strong potential to modify this behavior. The new law provides reimbursement for this intervention. There are no copays or deductibles for patients, and smoking-cessation services can include diagnostic, therapeutic, and counseling modalities in addition to prescription of pharmacotherapy.
Before this bill became law, only 24 state Medicaid programs paid ObGyns or other physicians for smoking-cessation counseling of pregnant patients, and five states provided no coverage at all. Now, all pregnant Medicaid patients can get this counseling, and you’ll be paid for this important service.
3. Payments to nonphysician providers in freestanding birth centers
Before the ACA became law, Medicaid was authorized to pay hospitals and other facilities operated by and under the supervision of a physician; no payments were authorized for services of an ambulatory center operated by other health professionals. The ACA authorizes Medicaid payments to state-recognized freestanding birth centers not operated by or under the supervision of a physician. A state that doesn’t currently license birth centers must pass legislation and license these centers before the centers can receive these payments.
Medicaid will also reimburse providers who practice in state-recognized freestanding birth centers, as long as the individuals are practicing within their state’s scope of practice laws and regulations. Because the type of provider is not specified but instead left up to each state’s scope of practice laws and regulations, this provision could allow for separate provider payments for physicians, certified nurse midwives, certified professional midwives, and doulas.
4. Immigrant coverage
Legal immigrants are bound by the individual coverage mandate and must purchase health insurance. These individuals are eligible for income-related premium credits and subsidies for insurance purchased through an exchange. Legal immigrants who are barred from Medicaid during their first 5 years in the United States (by earlier law) are eligible for premium credits only.
Undocumented immigrants are not eligible for Medicaid, premium credits, or subsidies and are barred from purchasing insurance in the exchange, even with their own money.
5. Postpartum depression
Health reform will help bring perinatal and postpartum depression out of the shadows by providing federal funds for research, patient education, and clinical treatment. For example, the federal Department of Health and Human Services (HHS) will:
- conduct research into the causes of, and treatments for, postpartum conditions
- create a national public awareness campaign to increase awareness and knowledge of postpartum depression and psychosis
- provide grants to study the benefits of screening for postpartum depression and psychosis
- establish grants to deliver or enhance outpatient, inpatient, and home-based health and support services, including case management and comprehensive treatment services for individuals with, or at risk for, postpartum conditions.
The National Institute of Mental Health is encouraged to conduct a 10-year longitudinal study on the mental health consequences of pregnancy. This study is intended to focus on perinatal depression.