Dozens crowded into the National Academies building in a snow-blanketed Washington last Wednesday morning to attend a meeting of the committee charged with making recommendations as to whether birth control and other women’s health services will be considered preventive healthcare—and thus available without a co-pay to enrollees in health insurance plans, including those offered through the Affordable Care Act. Among committee members—respected physicians and public health experts appointed by the Institute of Medicine—there seems to be little doubt about the preventive benefits of contraception, which is used by more than 38 million American women to avert countless unwanted pregnancies and abortions.
Yet, in this uncertain moment when the health reform law itself is under attack, the political question of whether contraception counts as prevention remains open—and subject to potentially long and fiery debate. While birth control has always been somewhat contentious, it has long been the more politically palatable cousin of abortion, with a constituency that included some antichoice members of Congress who supported it as a way to decrease abortions. But, healthcare reform has created a new battleground for the issue, and, with more conservatives now in Congress and state governments, birth control is shaping up to be a divisive issue in the coming legislative session.
After the wrangling over what would be included in the final bill, prochoice advocates lost big: in order to obtain insurance coverage for abortion, policy-holders will have to pay for it separately. But a provision to the healthcare reform law added by Senator Barbara Mikulski that required all new health insurance plans to cover preventive services for women with no out-of-pocket cost to patients survived. The problem is that the law doesn’t specify exactly which services should be on the list along with pap smears and other less controversial forms of health counseling and disease prevention. The other problem is that, after the fight over abortion coverage almost derailed healthcare reform, many politicians are now extremely skittish about coverage related to sex and women’s bodies, fearing it will damage public receptivity to the bill.
The Obama administration is moving cautiously on the issue. The Department of Health and Human Services appointed the committee to iron out the details of preventive services for women, giving it until August to come up with a final list. The committee is also discussing allowing insurers a grace period after the new rules are issued before they have to adhere to them. Douglas Laube, a veteran ob-gyn and chair of the board of Physicians for Reproductive Choice and Health, who attended a fall meeting with White House staff to discuss the issue, described members of the administration as appreciative of the importance of birth control—but also worried. "Nobody in that room disagreed," said Laube. "It all had to do with the potential political fallout."
Wednesday’s meeting—the committee’s second—was attended by a handful of antichoice activists who spoke during the open comment period. Many of them, including representatives from the US Conference of Catholic Bishops, argued that birth control isn’t prevention because pregnancy isn’t a disease. Mirroring the strategy abortion opponents took with health reform, several called for creating a pool of insurers who don’t offer contraception— "a virtuous option in health plans," as Michael O’Dea, executive director of the Christus Medicus Foundation in Michigan, a nonprofit devoted to "Christ-centered health care," put it. Several others argued that emergency contraception in particular shouldn’t be covered, since they see it as a form of abortion.