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The NuvaRing contraceptive ring can be used monthly to prevent pregnancy. (Getty Images)

Insurers Refuse To Cover Some Contraceptives, Despite Health Law

by Michelle Andrews
Aug 22, 2014

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How much leeway do employers and insurers have in deciding whether they'll cover contraceptives without charge and in determining which methods make the cut?

Not much, as it turns out, but that hasn't stopped some from trying.

People still write in regularly describing battles they're waging to get birth control coverage they're entitled to under the Affordable Care Act.

In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina monthly, works by releasing hormones like the ones in birth control pills.

She said her insurer told her she would be responsible for her contraceptive expenses unless she choose a generic birth control pill. The NuvaRing costs between $15 and $80 a month, according to Planned Parenthood.

Under the health law, health plans have to cover the full range of birth control methods approved by the Food and Drug Administration without any cost sharing by women.

There are some exceptions if the plan falls into a limited number of categories that are excluded. One is if the plan is grandfathered under the law. Those plans were around since March 23, 2010, or before, and haven't changed much. If your plan is grandfathered, it has to disclose that status to you.

The other exception is if the plan is offered by a religious employer or house of worship. Following the recent Supreme Court decision in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.

In addition, the federal government has given plans some flexibility by allowing them to use "reasonable medical management techniques" to keep their costs under control. So if there is both a generic and a brand-name version of a birth control pill available, for example, a plan could decide to cover only the generic version without cost to the patient.

As for the NuvaRing, even though they may use the same hormones, the pill and the ring are different methods of birth control. As an official from the Department of Health and Human Services said in an email, "The pill, the ring and the patch are different types of hormonal methods ... It is not permissible to cover only the pill, but not the ring or the patch."

Guidance from the federal government clearly states that the full range of FDA-approved methods of birth control must be covered as a preventive benefit without cost sharing. That includes birth control pills, the ring or patch, intrauterine devices and sterilization, among others.

But despite federal guidance, "we've seen this happen, plenty," says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. "Clearly insurance companies think things are ambiguous enough that they can get away with it."

If you are denied coverage, your defense is to appeal the decision, and get your state insurance department involved.

"The state has the right and responsibility to enforce this law," says Sonfield.

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A drawing of two clinking martini glasses. ( NPR)

Pop Culture Happy Hour: Live From The Bell House

Aug 22, 2014

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We had an absolutely fantastic time Tuesday night at the Bell House in Brooklyn doing the first-ever Pop Culture Happy Hour from New York. Everyone was wonderful, everyone was hugely supportive, and we were joined by our producer emeritus Mike Katzif for our roundtable discussion of the things we've loved this summer and the things we're excited about for fall. Along the way, we chatted about writing, the problems with the way networks promote fall shows, the challenges of prequels with predetermined conclusions and, most importantly, just how 10-year-old Glen would be feeling if we could talk to him right now.

Some of the things we talked about: the terrific Roxane Gay, who just recently wrote another of her powerful pieces that integrate food and prose; this intriguing trailer; some great writing from a friend of ours; a book that isn't out yet; a book that is out; and a review I was most proud to publish.

Find us on Facebook or follow us on Twitter: me, Stephen, Glen, Mike, and producer Jessica — who, even more than usual, was our fixer and handler and manager and helper, along with the team up in Programming at NPR and the folks at the Bell House, all of whom we're hugely grateful to this week. Next week at this time, we'll have the second half of our show, which was full of quizzes and fabulous special guests.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

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Palestinian mourners carry the body of three senior commanders of the Hamas military wing in the southern Gaza Strip Thursday, after they were killed in an Israeli airstrike. Hamas has executed more than a dozen people it says were spying for Israel. (AP)

Hamas Executes Suspected Informants After Deadly Israeli Strike

Aug 22, 2014

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One day after an Israeli airstrike killed three of its senior military leaders, Hamas says it has executed more than a dozen people in the Gaza Strip, after concluding that they had been spying for Israel.

From Jerusalem, NPR's Jackie Northam reports:

"Hamas confirmed that there were two separate rounds of executions in Gaza for people suspected of collaborating with Israel.

"In one instance, 11 men were rounded up recently and investigated by the Hamas government. They were found guilty and all 11 were sentenced to death.

"In another instance, three men were arrested yesterday and summarily executed. Analysts say these men were most likely accused of being linked to Israeli attacks yesterday which killed three high-ranking Hamas leaders, men who had led operations against Israel for the past two decades.

"Israel says it is ramping up its efforts to target senior leaders of the the al-Qassam Brigades, the armed wing of Hamas."

As we reported Thursday, one of the Hamas leaders killed in southern Gaza was Raed al Attar, its most important commander in that area. He and the other men were killed in an attack on a house. Earlier this week, the group's top military leader, Mohammed Deif, reportedly eluded a strike that killed his wife and two young children.

In Israel, Haaretz reports that the number of suspected informants who were executed has risen to 18, after a public execution was held in a town square in Gaza.

The website Ynet News describes what it says were the first public executions in Gaza since the 1990s:

"The victims, their heads covered and hands tied, were shot dead by masked gunmen dressed in black in front of a crowd of worshippers outside a mosque after prayers, witnesses and al-Majd, a pro-Hamas website, said."

Today, Israel and Hamas militants are continuing to launch airstrikes, rockets and mortars at one another, after a cease-fire failed early this week. The current conflict is now in its 46th day.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

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A Russian border guard opens a gate into the Ukraine for the first trucks from the Russian town of Donetsk, Rostov-on-Don region, on Friday. The convoy had been stalled near the border for more than a week. (AP)

Russian Convoy Crosses Ukraine Border Despite Kiev's Protests

Aug 22, 2014

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After being halted at the border for more than a week, a Russian aid convoy is rumbling into eastern Ukraine without permission, prompting Kiev to label the move a "direct invasion" of sovereign territory.

About 70 white trucks from a 260-strong convoy were moving toward the Luhansk region, an area in the country's east that is held by pro-Russia separatists, Reuters reports.

Earlier, Ukraine refused to allow the trucks across the border because it feared they might be carrying weapons and other militarily useful supplies for Moscow-backed rebels, or worse, be a prelude to a full-scale Russian invasion.

"That's something that Russia has denied, but both Western officials and officials in Kiev dispute that," NPR's Soraya Sarhaddi Nelson reports from eastern Ukraine. "They believe there is some indication that that is going on."

However, officials from the International Committee of the Red Cross inspected at least some of the vehicles and affirmed that they were carrying only humanitarian aid, she says.

"What the Red Cross has said is that there are humanitarian goods in the trucks that they've looked at - generators, blankets, water, food stuffs and these are things that are apparently in the trucks that are supposedly moving in the direction of Luhansk," Soraya says.

Reuters adds:

"Kiev, for its part, said Ukrainian forces would not attack the convoy and had allowed it to pass to avoid 'provocations.'

"'Ukraine will liaise with the International Committee of the Red Cross so that we, Ukraine, are not involved in provocations (accusations) that we have been holding up or using force against the vehicles of so-called aid,' he told journalists."

By way of background, The Associated Press writes:

"In the past few days, Ukraine says its troops have recaptured significant parts of Luhansk, the second-largest rebel-held city, and suspicions are running high that Moscow's humanitarian operation may instead be aimed at halting Kiev's military momentum. Fierce fighting has been reported both around Luhansk and the largest rebel-held city, Donetsk, with dozens of casualties.

"The International Committee of the Red Cross, which had planned to escort the Russian aid convoy to assuage fears that it was being used as a cover for a Russian invasion, said it had not received enough security guarantees to do so."

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When it carried out a tense prisoner exchange in May, the Pentagon misused nearly $1 million, the Government Accountability Office says. Army Sgt. Bowe Bergdahl was taken out of captivity in Afghanistan, as seen in this image from video obtained from the Voice Of Jihad Website. (AP)

U.S. Prisoner Swap For Bergdahl Broke The Law, GAO Says

Aug 22, 2014

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The Pentagon didn't give enough notice to Congress and misused nearly $1 million when it swapped Army Sgt. Bowe Bergdahl for five senior Taliban members, the Government Accountability Office says. The nonpartisan agency's findings led Defense officials to say they had to act quickly to free Bergdahl, who had been held for five years.

GAO investigators looked into the incident at the request of several Republican senators, including Minority Leader Mitch McConnell, R-Ky., and members of the Appropriations Committee.

The GAO's final report was released Thursday; it finds that the Pentagon violated the Department of Defense Appropriations Act when it didn't give 30 days' notice to Congress about its plan to move the five Taliban prisoners from Guantanamo Bay, Cuba, to Qatar.

Investigators also said that the transfer, which cost $988,400, was paid for out of an account of already-appropriated funds - a violation of the Antideficiency Act.

The GAO says Defense officials didn't notify members of Congress about the prisoner trade until May 31, the day the exchange took place in Afghanistan. And the agency says that the law now requires the Pentagon to report its violation of the Antideficiency Act.

Speaking in Congress weeks after the release, Defense Secretary Chuck Hagel called the situation "extraordinary" and "unique," with circumstances that were continuously developing.

The GAO's investigators say that the Pentagon's legal team believes it's not constitutional to apply part of the appropriations act to the Bergdahl operation, because it was carried out to protect an American service member. Defense officials also told the agency that giving advance notice would have interfered with the plan.

From the AP comes this response from Pentagon spokesman Rear Adm. John Kirby:

"The administration had a fleeting opportunity to protect the life of a U.S. service member held captive and in danger for almost five years," Kirby added. "Under these exceptional circumstances, the administration determined that it was necessary and appropriate to forgo 30 days' notice of the transfer in order to obtain Sgt. Bergdahl's safe return."

In its report, the GAO notes, "It is not our role or our practice to determine the constitutionality of duly enacted statutes."

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