Aug. 02--In a move that delighted health advocates, alarmed the insurance industry and angered religious conservatives, the Obama administration said Monday that it plans to require insurance companies to provide birth control services to women at no extra cost starting a year from now.
"For women's health, this is historic -- a really important turning point," said Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center.
Currently, women pay as much as $50 a month for birth control pills, even when they have insurance coverage, according to Dr. Allison Cowett, director of the Center for Reproductive Health at the University of Illinois at Chicago Medical Center. For many, this is a significant hardship and a disincentive to practice consistent birth control, she said.
Indeed, 95 percent of women who have unintended pregnancies report using contraception only occasionally or not at all -- often because it's too expensive, according to the Guttmacher Institute, a nonpartisan research organization. In addition to reducing unwanted pregnancies and abortion rates, birth control has been shown to improve maternal and child health.
Under new rules proposed Monday by the U.S. Department of Health and Human Services, insurers would be required to provide contraceptive services, breast-feeding support and supplies, domestic violence screening and counseling, regular "well woman" visits, counseling about HIV and sexually transmitted infections, screening for gestational diabetes, and several other preventive services without charging women any copayments.
The regulation would become effective Aug. 1, 2012, and apply only to insurance plans newly started or significantly changed after that date. The federal agency has the authority to impose the rule under last year's national health care overhaul.
Copayments are the amount people pay upfront when they fill a prescription or go to an appointment with a medical provider.
A committee of the Institute of Medicine, a highly influential arm of the National Academy of Sciences, had recommended two weeks ago that a broad array of preventive services for women be fully covered by insurance plans after reviewing extensive scientific evidence of their effectiveness. Linda Rosenstock, head of that panel and dean of the School of Public Health at the University of California at Los Angeles, called that report "a road map for improving the health and well-being of women."
All eight services endorsed by the Institute of Medicine are included in the new HHS recommendation.
For its part, the insurance industry is worried about the cost implications. "Unfortunately, the preventive care coverage recommendations recently issued by the IOM would increase the number of unnecessary physician office visits and raise the cost of coverage," said Karen Ignagni, president of America's Health Insurance Plans. Even if women don't pay upfront for services, they and others will pay through premium increases and other cost-sharing features, insurers predict.
The parent company for Blue Cross and Blue Shield of Illinois was reviewing the proposed guidelines and was not prepared to comment on their impact, said Gregory Thompson, a spokesman.
Conservative organizations said the administration had crossed a dangerous line. "We're concerned that the government would force pro-life Americans to pay through their private insurance plans for medications that may cause early abortions," said Carrie Gordon Earll, a spokeswoman for Focus on the Family in Colorado Springs.
All policyholders would end up paying for contraceptive services through insurance premiums, whether or not that violates their beliefs, she said.
Many conservative groups believe that contraception can act as an abortion agent, causing a fertilized egg to be sloughed off, though scientific evidence does not prove this is the case. The controversial "morning-after" pill would be among the forms of contraception covered.
While religious organizations would be granted an exemption under the rules proposed Monday, that provision appears to apply too narrowly to churches and to exclude religious groups that provide social services, among others, said Jeanne Monahan, director of the Center for Human Dignity at the Family Research Council in Washington, D.C.
The proposed rules are the latest effort to expand access to preventive medical care under the health care law passed last year. Last summer, the administration ruled that as of September 2010, new insurance plans had to cover basic services such as immunizations, colonoscopies, cholesterol checks and mammograms without charging copays. Existing insurance plans were excluded but become subject to the rules when significant changes are made in their benefit structures. Over time, the expectation is that relatively few plans will retain this exemption.
At the start of this year, the government followed up with a requirement that 45 million elderly and disabled Americans get annual wellness visits and flu shots without making upfront payments.
Illinois and 27 other states already require insurance companies to pay for contraception, but the laws typically don't waive copayments for birth control services or apply to self-funded insurance plans run by larger employers.
Relieving those economic burdens and extending the reach of regulation will "make an enormous difference to women," said Carole Brite, president of Planned Parenthood of Illinois.
jegraham@tribune.com
-----
To see more of the Chicago Tribune, or to subscribe to the newspaper, go to http://www.chicagotribune.com.
Copyright (c) 2011, Chicago Tribune
Distributed by McClatchy-Tribune Information Services.
For more information about the content services offered by McClatchy-Tribune Information Services (MCT), visit www.mctinfoservices.com.