Under the healthcare reform law, birth control and contraceptive counseling should be fully covered by health plans, according to a much-awaited report released today by the Institute of Medicine. The recommendations come from a panel of medical and public health experts that has been meeting over the past eight months to determine which women’s health services should be considered preventive—and therefore available without a co-pay.
The panel recommends full coverage of eight services, including screening for sexually transmitted diseases and lactation counseling. But the most contentious and closely watched issue has been whether it would recommend that birth control be available at no cost above a monthly premium.
The answer is a clear yes. The report specifies that “the full range of Food and Drug Administration-approved contraceptive methods should be covered,” going on to list the various options: barrier methods, hormonal methods, emergency contraception, implanted devices, and sterilization. It also recommends full coverage of patient education and counseling for “all women with reproductive capacity.”
If adopted, the recommendations will be a huge win for women, millions of whom are currently unable to afford birth control. Some 30 percent of sexually active low- and middle-income women now put off family planning visits to save money, according to a 2009 survey done by the Guttmacher Institute. Is it any surprise that 49 percent of all pregnancies in the United States are unplanned?
The gain from implementing the recommendations would be huge. Women who want to prevent pregnancy—for personal or medical reasons—would be able to do so at no cost. And those who are planning pregnancies will be better equipped to space them out. This is a huge step forward for children, not just their mothers, since babies born less than eighteen months after a birth are more likely to be premature, low birth-weight, and have other health problems. Women will also benefit from a reduction in the risk of ovarian cancer, which use of birth control pills has been shown to reduce.
Financially, women will be spared a huge burden. Birth control pills can cost more than $60 per month. Now, even most women whose plans “cover” birth control do so only partially, leaving them with an average cost of $14 per pack. Getting an IUD inserted can cost hundreds.
And while eliminating cost for birth control will represent a savings for women, over the long run, it will save the government money, too. Publicly supported family planning clinics save taxpayers $3.74 for every $1 that is spent providing contraceptive care, according to the Guttmacher Institute.
The verdict clearly qualifies as a political win, too. Polls consistently show widespread support for covering birth control without a co-pay. A survey conducted by Planned Parenthood last year found almost three-quarters of voters believed that insurers should be required to fully cover contraception. Another conducted this year by the National Family Planning and Reproductive Health Association found that 84 percent of respondents—including an impressive 73 percent of Republicans—support birth control as preventive care.
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With public opinion on their side, advocates are hopeful that some of that enthusiasm will give health reform a much-needed bump.
“We’re convinced that taking this step of adding contraception to the list will increase women’s awareness of the health reform law and therefore the people who supported the health reform law,” says Lois Uttley, of Raising Women’s Voices, one of several groups that have been pushing hard for contraceptive coverage. “Every single month, millions of women will be going to the pharmacy to refill their prescriptions and remembering that it was the Affordable Care Act that took that co-pay away.”
Others are hopeful that the decision will bring a winning issue to the fore in the coming elections. “You’ve got voters willing to vote the family planning issue and this increases salience,” says Democratic pollster Celinda Lake. If someone wants to defund family planning, says Lake, “voters will think ‘you’re out of touch, I disagree.’ ”
But the political process is not over. The IOM report represents expert scientific opinion. Now, the decision falls back to the political realm, as the Department of Health and Human Services prepares to make its final decision. However, “given that [Secretary of Health and Human Services Kathleen Sebelius] commissioned the scientific study and this what the group she contracted to came out with, I’d be surprised if she doesn’t endorse it,” says Judy Waxman, vice president of health and reproductive rights at the National Women’s Law Center.
Still, advocates on both sides aren’t taking any chances. Groups including the Family Research Council have already denounced the report, claiming that certain contraceptives act as abortifacients. Meanwhile, reproductive health groups are preparing to deliver a petition urging the Obama administration to take the advice of its own panel to Sebelius. And on Thursday, Planned Parenthood and the National Women’s Law Center will be hosting a blog carnival in favor of the recommendations (not to be outdone, the antis have a blog carnival of their own). The message they’re hoping to send is that implementing the report’s recommendations isn’t just the right thing to do medically—it’s politically savvy, too.
