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The New York Times, July 19, 2011

Panel Recommends Coverage for Contraception
By Robert Pear

WASHINGTON — A leading medical advisory panel recommended on Tuesday that all insurers be required to cover contraceptives for women free of charge as one of several preventive services under the new health care law.

Obama administration officials said that they were inclined to accept the panel’s advice and that the new requirements could take effect for many plans at the beginning of 2013. The administration signaled its intentions in January when Kathleen Sebelius, the secretary of health and human services, unveiled a 10-year program to improve the nation’s health. One goal was to “increase the proportion of health insurance plans that cover contraceptive supplies and services.”

Administration officials, who say they hope to act on the recommendations by Aug. 1, are receptive to the idea of removing cost as a barrier to birth control — a longtime goal of advocates for women’s rights and experts on women’s health.

But the recommendations immediately reignited debate over the government’s role in reproductive health. Women’s groups and medical professionals applauded the recommendations while the Roman Catholic Church raised strenuous objections.

The recommendations came in a report submitted to Ms. Sebelius by the Institute of Medicine, an arm of the National Academy of Sciences. The new health care law says insurers must cover “preventive health services” and cannot charge for them. Ms. Sebelius will decide on a minimum package of essential health benefits, and her decision will not require further action by Congress.

The panel said insurers should be forbidden to charge co-payments for contraceptives and other preventive services because even small charges could deter their use. The recommendation would not help women without insurance.

The administration asked the Institute of Medicine, a nonpartisan, nongovernmental arm of the National Academy of Sciences, to help identify the specific services that must be covered for women.

“This report is historic,” Ms. Sebelius said on Tuesday in accepting the document. “Before today, guidelines regarding women’s health and preventive care did not exist. These recommendations are based on science and existing literature.”

In addition to contraceptive services for women, the panel recommended that the government require health plans to cover screening to detect domestic violence; screening for H.I.V., the virus that causes AIDS; and counseling and equipment to promote breastfeeding, including the free rental of breast pumps.

The panel also said all insurers should be required to cover screening for gestational diabetes in pregnant women; DNA testing for the human papillomavirus as part of cervical cancer screening; and annual preventive-care visits. Such visits could include prenatal care and preconception care, to make sure women are healthy when they become pregnant.

Defending its recommendations on contraceptive coverage, the panel said that nearly half of all pregnancies in the United States were unintended, and that about 40 percent of unintended pregnancies ended in abortion. Thus, it said, greater use of contraception would reduce the rates of unintended pregnancy, teenage pregnancy and abortion.

The chairwoman of the panel, Dr. Linda Rosenstock, dean of the School of Public Health at the University of California, Los Angeles, said, “We did not consider cost or cost-effectiveness in our deliberations.”

But the panel’s report says that “contraception is highly cost-effective,” averting unintended pregnancies that would be far more expensive than contraception.

To reduce unintended pregnancies, the panel said, insurers should cover the full range of contraceptive methods approved by the Food and Drug Administration, as well as sterilization procedures and “education and counseling for all women with reproductive capacity.”

This recommendation would require coverage of emergency contraceptives including pills like ella and Plan B, panel members said.

Under rules issued last year, many health plans are already required to cover numerous preventive services like blood pressure and cholesterol tests, colonoscopies and other cancer screenings, and routine vaccinations. A provision of the law drafted by Senator Barbara A. Mikulski, Democrat of Maryland, requires coverage of “additional preventive care and screenings” for women.

Most private insurance provides contraceptive coverage, but co-payments have increased in recent years, the panel said.

The report touched off a fierce debate Tuesday. Obstetricians, gynecologists, public health experts and Democratic women in Congress hailed the recommendations.

“We are one step closer to saying goodbye to an era when simply being a woman is treated as a pre-existing condition,” Ms. Mikulski said. “We are saying hello to an era where decisions about preventive care and screenings are made by a woman and her doctor, not by an insurance company.”

Representative Lois Capps, Democrat of California, said the recommendations would remove cost as a barrier to birth control — and in hard economic times like these, she said, cost can be a formidable barrier.

The United States Conference of Catholic Bishops and some conservative groups, including the Family Research Council, denounced the recommendation on birth control.

“Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed,” said Deirdre A. McQuade, a spokeswoman for the bishops’ Pro-Life Secretariat. “But the Institute of Medicine report treats them as such.”

Ms. McQuade expressed deep concern about requiring coverage of surgical sterilizations and contraceptive drugs and devices.

Jeanne Monahan, the director of the Center for Human Dignity at the Family Research Council, said: “Some people have moral or ethical objections to contraceptives. They should not be forced to violate their conscience by paying premiums to health plans that cover these items and services.”

One panel member, Prof. Anthony Lo Sasso, a health economist at the University of Illinois at Chicago, filed a dissent, saying the committee did not have enough time to conduct “a serious and systematic review” of the evidence.

The report, he said, includes “a mix of objective and subjective determinations filtered through a lens of advocacy.”

© 2011 The New York Times Company

This article originally appeared here.

Photo © Paul S. Hamilton