In a statement, Sebelius praised the committee’s work as “historic” and “based on science and existing literature.”
“We are reviewing the report closely and will release the department’s recommendations . . . very soon,” she added.
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. Their conscience rights should be protected,” she said.
Just as troubling, said Monahan, was the 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 primarily work by inhibiting ovaries from releasing eggs. But antiabortion advocates argue that there is evidence the drugs can also prevent an already-fertilized egg from implanting in the womb, which they consider equivalent to abortion.
Adam Sonfield, a public policy expert at the Guttmacher Institute, a nonprofit research center, countered that the scientific basis for such claims 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 anti-contraception,” 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 to 99 percent of women overall.
Other research by Guttmacher suggests that those with health insurance are already very likely to get some degree of birth-control coverage from their health plans. This is at least partly because of a recent surge in state laws mandating such coverage as well as a federal law that, since 2000, officials have interpreted to require employers to include contraception if they pay for other preventive services and prescription drugs. In 1998, Congress also added a birth-control coverage requirement to health plans for federal employees.
Still, none of these mandates require plans to cover contraception without co-pays 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 Guttmacher.
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 experts, most prominently the U.S. Preventive Services Task Force.
However, because that task force has historically paid less attention to gender-specific recommendations, the law’s drafters added a requirement that the Department of Health and Human Services issue a supplementary list for women.
Women’s health advocates pronounced themselves 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 exam.
“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 “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 in coming years, such 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.