Gov't advisers: Cover birth control for free


An Institute of Medicine panel recommended that the government require health insurance companies to cover birth control for women as preventive care, without copayments. Contraception -- along with such care as diabetes tests during pregnancy and screening for the virus that causes cervical cancer -- was one of eight recommended preventive services for women.

"Unintended pregnancies carry health consequences for the mother -- psychological, emotional and physical -- and also consequences for the newborn," said Dr. Linda Rosenstock, panel chairwoman and dean of public health at the University of California, Los Angeles. "The overwhelming evidence was strongly supportive of the health benefit" of contraception.

A half century after the introduction of the birth control pill, the panel's recommendations may help to usher in another revolution. Medical experts say easier access could start a shift to more reliable forms of long-acting birth control, such as implants or IUDs, which are gaining acceptance in other economically developed countries. Emergency contraception, known as the morning-after pill, would also be covered.

All but one member of the 16-person IOM panel supported the final recommendations.

President Barack Obama's health care law already requires most health plans to provide standard preventive care for people of both sexes at no additional charge to patients. Women's health recommendations were considered new and politically sensitive territory, so the nonpartisan institute was asked to examine the issue.

Nonetheless, a fight over social mores is brewing. Catholic bishops and other religious and social conservatives say pregnancy is a healthy condition and the government should not require insurance coverage of drugs and other methods that prevent it. (Most health plans already cover contraception.)

The conservative Family Research Council said the recommendations could lead to a federal "mandate" for abortion coverage, since emergency contraceptives such as Plan B and Ella would be covered. But the Food and Drug Administration classifies those drugs as birth control, not abortion pills. Panel member Alina Salganicoff, women's health policy director for the Kaiser Family Foundation, said abortion drugs are not included in the recommendations.

Short of repealing part of the health care law, it's unclear what opponents can do to block the recommendations. A final decision by Health and Human Services Secretary Kathleen Sebelius is expected around Aug. 1.

Sebelius called the recommendations "historic," saying they are based on science.

"We are one step closer to saying goodbye to an era when simply being a woman was treated as a pre-existing condition," said Sen. Barbara Mikulski, D-Md., who sponsored the women's health amendment.

Under the law, the earliest the final requirements would take effect is next year. In most cases, it's likely to be Jan.1, 2013.

Birth control use is virtually universal in the United States. 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 a major reason. Experts say a shift to longer acting birth control would help.

Contraception is about more than simply preventing pregnancy -- it 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 discourage use.

Other preventive services recommended by the IOM panel include:

--At least one "well-woman" preventive care visit annually.

--Annual HIV counseling and screening for sexually active women.

--Screening for and counseling about domestic violence.

--Annual counseling on sexually transmitted infections for sexually active women.

--Support for breast feeding mothers, including the cost of renting pumps.

The screening for the virus that causes cervical cancer is for women starting at age 30, no more frequently than every three years. As for the pregnancy diabetes check, it should come at the first prenatal visit for high-risk women, and between 24 and 28 weeks for all others.

Although the services will be free of any additional charge to patients, somebody has to pay. The cost is likely to be spread among other people with health insurance, resulting in slightly higher premiums.

Dissenting panel member Anthony Lo Sasso, a senior research professor at the University of Illinois school of public health, cited the lack of a cost-benefit analysis as a reason for his disapproval. Panel chair Rosenstock said the group was not asked to consider cost.

It's unclear how easy it will be to take advantage of the no-copay rule in the doctor's office. Consider: A woman sees the doctor about pain in her hip -- paying the required the copay -- but during the same visit, receives her overdue screening for cervical cancer.

The Health and Human Services Department should require that the woman not be charged lab fees for that cervical test, said Cynthia Pearson of the National Women's Health Network.

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