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Panel calls birth control routine care for women

Urges coverage by insurers with no extra charges

By N.C. Aizenman
Washington Post / July 20, 2011

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WASHINGTON - Virtually all health insurance plans could soon be required to offer female patients free coverage of prescription birth control, breast-pump rentals, counseling for domestic violence, and annual wellness exams and HIV tests as a result of recommendations released yesterday by an independent advisory panel of health specialists.

The health care law adopted last year directed the Obama administration to draw up a list of preventive services for women that all new health plans must cover without deductibles or copayments. While the guidelines suggested yesterday by a committee of the National Academy of Sciences’ Institute of Medicine are not binding, the panel conducted its yearlong review at the request of Health and Human Services Secretary Kathleen Sebelius.

Sebelius praised the committee’s work as historic and said it was “based on science and existing literature.’’

“We are reviewing the report closely and will release the department’s recommendations . . . very soon,’’ she said.

Although generally expected, the committee’s decision to put the full range of Food and Drug Administration-approved contraceptives and sterilization procedures on its proposed list ignited immediate controversy.

Jeanne Monahan, director of the Center for Human Dignity at the socially conservative Family Research Council, said that many Americans may object to birth control on religious grounds. “They should not be forced to have to pay into insurance plans that violate their consciences,’’ she said. “Their conscience rights should be protected.’’

Just as troubling, Monahan said, was inclusion of emergency contraceptives such as the so-called morning-after pill sold as Plan B and the more recently approved drug sold as Ella. Both work primarily by inhibiting ovaries from producing eggs. But abortion opponents argue that there is evidence the drugs can also prevent a fertilized egg from implanting in the womb, which they consider equivalent to abortion.

Adam Sonfield - a public policy specialist at the Guttmacher Institute, a nonprofit research center - countered that the scientific basis for such arguments is highly questionable and that, in any case, the medical field defines pregnancy as beginning with the implantation, not the fertilization, of an egg.

“They are purposely trying to confuse the American public about what contraception is and to try to tar it as abortion because . . . in truth, they are not just antiabortion; they are anticontraception,’’ he said. “And they know the American public overwhelmingly supports contraception.’’

For instance, Sonfield said, a Guttmacher study found that 98 percent of sexually active Catholic women and nearly 100 percent of evangelicals have used contraception at some point, compared with 99 percent of women overall.

Still, none of these mandates require plans to cover contraception without copayments or other forms of cost-sharing. And there is evidence that the out-of-pocket cost may discourage many women from using birth control as consistently as they would like: About half of all pregnancies are unplanned, according to the Guttmacher Institute.

The rules on preventive services for women complement a broader provision in the new health care law that already requires plans to offer free preventive care for men, women, and children from lists drafted by other panels of independent scientific specialists, most prominently the US Preventive Services Task Force.

However, because that task force has historically paid less attention to gender-specific recommendations, the law’s drafters required that the Department of Health and Human Services issue a supplementary list for women.

Women’s health advocates said they were delighted that the Institute of Medicine committee had chosen to recommend not only the widest possible range of contraceptive services, but also an expansive spectrum of other preventive services.

These include screening for gestational diabetes in pregnant women; more sophisticated testing for a virus, known as HPV, that is associated with cervical cancer; annual counseling for sexually active women on sexually transmitted infections; and multiple visits to obtain preventive services if they cannot be provided in one annual examination.

“We’re very pleased about the scope of these recommendations,’’ said Judy Waxman of the National Women’s Law Center. “Assuming HHS adopts them, I expect a big impact on women’s health.’’

Insurers will need to follow the new guidelines at the start of the next plan year, within one year after Sebelius issues them.

The administration estimates that 41 million Americans are in new employer or individual plans to which the rules will apply. An additional 98 million people are covered by so-called grandfathered policies exempt from the new rules. But such plans can lose grandfathered status if they make a host of changes to their coverage and payment policies, so their number is expected to dwindle rapidly, so that by 2013, 47 million more Americans will be in employer plans covered by the new rules.

The guidelines will also largely apply to plans covering federal employees, but not to Medicare, Medicaid, or TriCare. Medicaid and TriCare already offer contraceptive coverage, with Medicaid offering it at no cost.