By Bruce Alpert
With the U.S. Supreme Court affirming the Affordable Care Act's constitutionality and Republicans so far unable to repeal it, provisions of the law are taking effect in advance of full implementation slated for 2014. Wednesday was the deadline to mail or provide credit card refunds for policyholders in cases where insurance companies didn't, as the law requires, spend at least 80 percent of premiums on health care rather than administrative or other non-care-related expenses.
Nationally, 5.5 million beneficiaries are getting rebates averaging $135 per person. In Louisiana, companies came closer to the 80 percent requirement, as 51,627 insurance policy holders are getting rebates checks averaging only $43.
Another provision taking effect Wednesday requires health insurance plans to provide services and tests for women with no out-of-pocket costs, including co-pays.
Many are noncontroversial such as Pap smears, cancer screenings, diabetes screenings, as well as domestic violence counseling and breast feeding counseling. But a requirement that mandates health insurance plans provide coverage for contraception remains controversial.
The U.S. Catholic Bishops said that providing the coverage runs counter to their religion's objection to artificial birth control and they have rejected an Obama administration proposal that would require insurance companies to provide the coverage without cost for plan sponsors that object to birth control.
The matter is now in the courts and has been temporarily blocked from being implemented in one state -- Colorado -- while legal proceedings continue.
At a news conference this week, a group of Democratic senators, including Mary Landrieu of Louisiana, focused on the less controversial provisions being implemented this week under the Affordable Care Act, which was passed with only Democratic votes in 2010.
"For Louisiana, the state I represent, over 600,000 women ... will be able to access these services to keep themselves healthy and well, women that are working minimum-wage jobs or women that show up at the highest levels at some of the largest companies at the corporate level," Landrieu said.
Health and Human Services Secretary Kathleen Sebelius said the new provisions will make a real difference for women.
"No women should have to choose between seeing her doctor and putting food on the table for her family and, now, many women won't have to make that difficult choice any longer," Sebelius said.
And next year, she said, "it will be illegal for companies to deny someone coverage because they're a breast cancer survivor or pregnant or a victim of domestic violence."
Rep. Bill Cassidy, R-Baton Rouge, who has joined other Republicans in unsuccessful efforts to repeal the Affordable Care Act as overly bureaucratic and expensive, said he's not impressed.
"Despite what HHS is saying, these health services and rebates are not free," said Cassidy, a physician. "The costs are passed back to the people paying the insurance."
Cassidy cited a report by a Harvard professor who warns that some women will be more vulnerable to layoffs because of the mandates.
Rep. Steve Scalise, R-Jefferson, focused on provisions that require employers to provide health coverage that includes birth control, including sterilization, even if they have moral objections.
"President Obama's sterilization and contraception mandate blatantly violates the religious freedoms guaranteed by the U.S. Constitution by forcing thousands of businesses and individuals to violate their religious beliefs in order to comply with this latest Obamacare mandate," Scalise said.
Rep. Charles Boustany, R-Lafayette, a doctor, said the contraception mandate includes so-called emergency contraception drugs that "can destroy a pregnancy and prevent implantation of a human embryo."
But Sen. Tom Harkin, D-Iowa., said the administration has offered a reasonable compromise to those with moral objections to birth control. And he said that not all women who use birth control do so to prevent pregnancies -- many "take birth control pills" to treat medical problems such as serious menstrual cramps, he said.