Insurance Coverage for Contraception Is Required
WASHINGTON — The Obama administration issued new standards on Monday that require health insurance plans to cover all government-approved contraceptives for women, without co-payments or other charges.
The standards, which also guarantee free coverage of other preventive services for women, follow recommendations from the National Academy of Sciences and grew out of the new health care law.
“These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” said Kathleen Sebelius, the secretary of health and human services.
The requirements apply to insurance in years starting on or after Aug. 1, 2012. They take effect in January 2013 for insurance plans that operate on the basis of a calendar year.
Supporters of the new requirement said it would go a long way toward 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 requirement does not immediately help women who have no health insurance.
It is sure to reignite debate over the federal role in health care at a time when Republicans in Congress are trying to repeal the health care law signed last year by President Obama.
A major goal of the law is to increase the use of preventive services like mammograms, colonoscopies, blood pressure checks and childhood immunizations. The law generally bans co-payments, deductibles and other charges for preventive services recommended by expert professional organizations. The law directed federal health officials to pay attention to the health needs of women in particular when listing preventive services that must be covered.
The new standards require coverage of the full range of contraceptive methods approved by the Food and Drug Administration, as well as sterilization procedures. Among the drugs and devices that must be covered are emergency contraceptives including pills known as ella and Plan B.
Senator Richard Blumenthal, Democrat of Connecticut, said, “These guidelines will save countless dollars and lives, and send a hugely powerful message about the importance of women’s preventive health care.”
Representative Lois Capps, Democrat of California, also praised the requirements, saying they would “ensure that women have increased access to the services they need to be healthy.”
The United States Conference of Catholic Bishops and some conservative groups, including the Family Research Council, have strenuously opposed any requirement for coverage of contraceptives.
Health plans offered by certain religious employers would be exempt from the requirement to cover contraceptive services. This provision is similar to the exemption for churches found in many of the states that already require coverage of contraception, federal health officials said.
Researchers have found that people who have coverage of preventive services, under Medicare or private insurance, use them much less than recommended. Federal officials said they would try to promote their use by publicizing the fact that wider, cost-free coverage is now available.
The National Academy of Sciences said the Obama administration had told its experts not to consider “the cost-effectiveness of screenings or services” in deciding which ones to recommend. Insurers expressed concern that coverage for some of the newly required preventive services could be costly.
Under the federal rules governing preventive services, insurers can use “reasonable medical management techniques” to control costs and promote the efficient delivery of care. The administration said Monday, for example, that an insurer could charge co-payments for brand-name drugs if a lower-cost generic version was available and was just as safe and effective.
In addition to contraceptive services for women, the government will 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 breast-feeding, including breast pumps.
Other preventive services that must be covered, without co-payments, include 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.
In a report commissioned by the Obama administration, the academy’s Institute of Medicine said free contraceptive coverage was justified because nearly half of all pregnancies in the United States were unintended, and about 40 percent of unintended pregnancies ended in abortion. Thus, it said, greater use of contraception will reduce the rates of unintended pregnancy, teenage pregnancy and abortion.
Certain health plans that were in place on March 23, 2010, when Mr. Obama signed the health care law, may be able to avoid the requirement to cover preventive services for a while. But as time passes and insurers and employers modify their coverage, the number of plans entitled to such “grandfather status” is shrinking.
© 2011 The New York Times Company
This article originally appeared here.
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