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Covering contraception could save $14.5 billion a year; IOM also recommends coverage of preventative health exams and screenings for domestic violence, cervical cancer, HIV, STDs, gestational diabetes and more


Source: Women's Health Policy Report, published by the National Partnership for Women & Families,  


July 20, 2011 (Women’s Health Partnership)— July 20, 2011 — U.S. Health and Human Services (HHS) should require that new health plans cover all FDA-approved contraception without cost-sharing by consumers under the federal health reform law, an Institute of Medicine panel said in guidelines issued on Tuesday, Politico reports.



Last year, HHS Secretary Kathleen Sebelius asked the independent panel to examine what constitutes a "preventive service" for women as part of a provision in the reform law that requires health plans to cover such services without copayments or deductibles. Sebelius said the department is examining the panel's recommendations "closely" and will make a final decision "very soon" (Nocera, Politico, 7/19). The New York Times reports that Sebelius could issue the final regulations by Aug. 1. According to the Times, the Obama administration has said it is inclined to adopt the panel's recommendations, which could take effect for many plans in early 2013. Sebelius called the IOM report "historic," noting that prior to the assessment, "guidelines regarding women's health and preventive care did not exist" (Pear, New York Times, 7/19).


The panel urged coverage for "the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling." The recommendations were endorsed by 15 of the 16 panel members. The committee wrote that contraceptive coverage is now "standard practice" for most private insurers and federal insurance programs. The National Business Group on Health since 2007 has urged coverage of family planning services with no cost-sharing requirements (Levey, Los Angeles Times, 7/20).


Other Recommendations


In total, IOM recommended that eight preventive services for women be covered without out-of-pocket fees: domestic violence screening and counseling services, advanced screenings for cervical cancer and human papillomavirus for women ages 30 and older, counseling for sexually transmitted infections and HIV, screening for gestational diabetes for pregnant women, and comprehensive coverage of breastfeeding equipment and support. The report also requires coverage for at least one annual preventive health exam.


According to the Wall Street Journal, the report did not indicate how much all the recommendations would cost (Hobson, Wall Street Journal, 7/20). However, the report noted that the direct medical costs of unintended pregnancy in the U.S. were an estimated $5 billion in 2002, while the cost savings from contraceptive use in the same year were an estimated $19.3 billion.


Contraception should be accessible "so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes," the panel wrote in the report (Park, CNN, 7/19). According to the Washington Post, the rules regarding preventive services for women are part of a broader provision in the federal health reform law that requires plans to provide coverage without additional cost-sharing for preventive care services for men, women and children (Aizenman, Washington Post, 7/19). An amendment to the law introduced by Sen. Barbara Mikulski (D-Md.) required that the overhaul examine and grant "additional preventive care and screenings" for women (New York Times, 7/19).


"The eight services we identified are necessary to support women's optimal health and well-being," said Linda Rosenstock, dean of UCLA's School of Public Health and the panel's chair, said, adding, "Each recommendation stands on a foundation of evidence supporting its effectiveness." According to the National Journal, while HHS decides what goes into the final regulations, Congress may offer suggestions (Fox/McCarthy, National Journal, 7/19).




An HHS official said that if the department were to adopt the recommendations by Aug. 1, "non-grandfathered plans would have to cover [contraception] in the first plan year beginning after Aug. 1, 2012. For many plans, this will be Jan. 1, 2013." The official said that in 2011, "an estimated 31 million people in new employer plans and 10 million people in new individual plans will benefit from the new prevention provisions under the Affordable Care Act. The number of individuals in employer plans who will benefit from the prevention provisions is expected to rise to 78 million by 2013, for a total potential of 88 million Americans whose prevention coverage will improve due to the new policy." Meanwhile, "many of the 98 million people in group health plans that are expected to be 'grandfathered' and thus not subject to these regulations already have preventive services," the official explained (Reichard, CQ HealthBeat, 7/19).


Advocates Laud Recommendations


Women's health advocates and Democratic lawmakers, who have pushed for the policies for years, praised the panel's recommendations.


Nancy Keenan, president of NARAL Pro-Choice America, said, "Currently, nearly one in three women finds it difficult to pay for birth control, and that's why the United States has a far higher unintended pregnancy rate than other industrialized country" (National Journal, 7/19).


Cecile Richards, president and CEO of the Planned Parenthood Federation of America, said birth control without out-of-pocket expenses "would be a tremendous stride forward for women's health in this country" (Wall Street Journal, 7/20).


Adam Sonfield, senior public policy associate at the Guttmacher Institute, said, "This will level a playing field for women who cannot afford more expensive, longer lasting forms of contraceptives and allow for a choice of methods that works best for them. This will improve effective use of contraception and prevent unplanned pregnancies" (Politico, 7/19).


The American Prospect notes that women of reproductive age pay 68% more in out-of-pocket health care costs than their male counterparts, mostly because of reproductive care. Fourteen million women do not use contraception or use it ineffectively because of cost reasons (Levy, American Prospect, 7/19).


Mikulski said, "We are one step closer to saying goodbye to an era when simply being a woman is treated as a pre-existing condition," adding, "We are saying hello to an era where decisions about preventive care and screenings are made by a woman and her doctors, not by an insurance company" (New York Times, 7/19).


The Nation reports that the report "clearly qualifies as a political win," as the vast majority of the public believes that insurers should be require to fully cover contraception. Lois Uttley of Raising Women's Voices said, "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" (Lerner, The Nation, 7/19).


Critics React


Anthony Lo Sosso of the University of Illinois, the sole dissenting member of the panel, said that the committee did not have time to fully assess all the evidence and that many of the decisions were made based on politics. "[T]he committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee's composition," he wrote, adding, "Troubling, the process tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy" (Politico, 7/19).


Robert Zirkelbach, press secretary for American's Health Insurance Plans, said, "Broadening the scope of mandated preventive services that go beyond or conflict with the current evidence-based guidelines will increase the cost and coverage for individuals, families and employers."


Sen. Richard Burr (R-N.C.) said he does not think there should be any "free" services provided by insurers, adding, "All of health care should have some out-of-pocket cost sharing. One reason why health care spending is at the level it is is because a lot of people perceive it to be free. That's a utilization nightmare" (CQ HealthBeat, 7/19).


The information contained in this publication reflects media coverage of women’s health issues and does not necessarily reflect the views of the National Partnership for Women & Families or East County Magazine. Reprinted with permission.


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