Another hurdle for health reform’s contraceptives mandate

It wouldn’t be a Friday afternoon without a federal regulation dump, and today is no exception. The White House has just put out new rules on its contraceptives mandate that, among other things, could disappoint some college students.

The administration estimates that, under the new rules, about one-fifth of student health plans will not be required to provide birth control without copay--or comply with any of the other benefit mandates in the Affordable Care Act, for that matter.

Why not? It gets pretty far into the weeds of insurance regulation, but the thing to know is this: The administration estimates there are 1 million college students covered by university health insurance plans. And about 200,000 of those students are in plans that self-insure, meaning that the university collects premiums directly from students rather purchasing a health plan from an insurance company on behalf of workers.

Those plans have generally been regulated at the state level. And, after studying the issue, the administration does not believe it has the authority to regulate these kinds of plans. Because of that, the federal government can’t tell these plans what it has to cover, in a way it can with most other plans. ability to regulate most other insurance products. In other words, the White House doesn’t think it can tell these plans to cover contraceptives without copay. Nor does it have the authority to mandate other Affordable Care Act benefits like coverage of other preventive services at no cost.

How much will this matter? I asked Aaron Smith, president of Young Invincibles, which has been lobbying the administration on these regulations for months now. He says that overall, they’re pretty happy with how the regulation came out. Student plans that self-insure, he points out, tend to be at more elite universities such as Harvard that have robust benefit packages. And, for the majority of college students, the new benefit mandates will apply.

“They tend to be better plans already,” says Smith of the self-insured college plans. “The schools that are well-endowed tend to self-insure, so it’s not a rampant problem. But that was their judgement, that they didn’t have the legal authority...and overall we think that the college health plan rules are very strong and will be very beneficial.”

If anything, this speaks to the complexity of insurance regulation in the United States. Most of it is done on the state level; every state has an insurance commissioner who sets the ground rules for selling insurance there. If those states want to mandate the benefits in the Affordable Care Act for all student health plans they can do that. But they certainly are not required to.