WASHINGTON (AP) - Health insurance plans must cover birth
control as preventive care for women, with no copays, the Obama
administration said Monday in a decision with far-reaching
implications for health care as well as social mores.
The requirement is part of a broad expansion of coverage for
women's preventive care under President Barack Obama's health care
law. Also to be covered without copays are breast pumps for nursing
mothers, an annual "well-woman" physical, screening for the virus
that causes cervical cancer and for diabetes during pregnancy,
counseling on domestic violence, and other services.
"These historic guidelines are based on science and existing
(medical) literature and will help ensure women get the preventive
health benefits they need," said Health and Human Services
Secretary Kathleen Sebelius.
The new requirements will take effect Jan. 1, 2013, in most
cases. Tens of millions of women are expected to gain coverage
initially, and that number is likely to grow with time. At first,
some plans may be exempt due to a complex provision of the health
care law known as the "grandfather" clause. But those even plans
could face pressure from their members to include the new benefit.
Sebelius acted after a near-unanimous recommendation last month
from a panel of experts convened by the prestigious Institute of
Medicine, which advises the government. Panel chairwoman Linda
Rosenstock, dean of public health at the University of California,
Los Angeles, said that prevention of unintended pregnancies is
essential for the psychological, emotional and physical health of
As recently as the 1990s, many health insurance plans didn't
even cover birth control. Protests, court cases, and new state laws
led to dramatic changes. Today, almost all plans cover prescription
contraceptives - with varying copays. Medicaid, the health care
program for low-income people, also covers contraceptives.
Indeed, a government study last summer found that birth control
use is virtually universal in the United States, according to a
government study issued last summer. More than 90 million
prescriptions for contraceptives were dispensed in 2009, according
the market analysis firm INS health. Generic versions of the pill
are available for as little as $9 a month. Still, about half of all
pregnancies are unplanned. Many are among women using some form of
contraception, and forgetting to take the pill is a major reason.
Preventing unwanted pregnancies is only one goal of the new
requirement. Contraception can help make a woman's next pregnancy
healthier by spacing births far enough apart, generally 18 months
to two years. Research links closely spaced births to a risk of
such problems as prematurity, low birth weight, even autism.
Research has shown that even modest copays for medical care can
In a nod to social and religious conservatives, the rules issued
Monday by Sebelius include a provision that would allow religious
institutions to opt out of offering birth control coverage.
However, many conservatives are supporting legislation by Rep. Jeff
Fortenberry, R-Neb., that would codify a range of exceptions to the
new health care law on religious and conscience grounds.
"It's a step in the right direction, but it's not enough,"
said Jeanne Monahan, a policy expert for the conservative Family
Research Council. As it now stands, the conscience clause offers
only a "fig leaf" of protection, she added, because it may not
cover faith-based groups engaged in social action and other
activities that do not involve worship.
Although the new women's preventive services will be free of any
additional charge to patients, somebody will have to pay. The cost
will be spread among other people with health insurance, resulting
in slightly higher premiums. That may be offset to some degree with
savings from diseases prevented, or pregnancies that are planned to
minimize any potential ill effects to the mother and baby.
The administration did allow insurers some leeway in determining
what they will cover. For example, health plans will be able to
charge copays for branded drugs in cases where a generic version is
just as effective and safe for the patient.
The requirement applies to all forms of birth control approved
by the Food and Drug Administration. That includes the pill,
intrauterine devices, the so-called morning-after pill, and newer
forms of long-acting implantable hormonal contraceptives that are
becoming widely used in the rest of the industrialized world.
Coverage with no copays for the morning-after pill is likely to
become the most controversial part of the change. The FDA
classifies Plan B and Ella as birth control, but some religious
conservatives see the morning-after drugs as abortion drugs. The
rules HHS issued Monday do not require coverage of RU-486 and other
drugs to chemically induce an abortion.
Advocates say the majority of women will be covered once the
requirement takes effect in 2013, although some insurance plans may
opt to offer the benefit earlier. Aside from the conscience clause,
the only other major exemption is for so-called "grandfathered"
plans, many of which are offered by large employers. With the
passage of time, however, many currently grandfathered plans are
likely to lose that designation as they make routine changes
affecting their benefits. Consumers should check with their health
insurance plan administrator.
(Copyright 2011 by The Associated Press. All Rights Reserved.)