August 3, 2011

LAST YEAR’S health-care reform law ushered in a new approach to encouraging preventive medicine. It required new insurance plans to cover preventive services free of copayments or other charges. The law left it to the Institute of Medicine to make the initial recommendations about what services should be covered. Last month, the institute sensibly recommended that all FDA-
approved contraceptives be included. This week, the Obama administration announced that it would adopt those guidelines. This is the right move, but one complicated by the fact that some people have moral or religious objections to some or all contraceptives.

It makes enormous sense to include contraception among preventive services. Nearly half of all pregnancies are unplanned, according to the Guttmacher Institute, and about 40 percent of women who find themselves with an unwanted pregnancy opt for abortion. Encouraging and underwriting contraception reduces the number of abortions. Moreover, the decision by Health and Human Services Secretary Kathleen Sebelius to include free coverage of contraceptives merely reflects and reinforces reality: Nine out of every 10 employer-based insurance plans already cover all FDA-approved methods of birth control, the Guttmacher Institute says. And 27 states have passed laws requiring insurers covering any prescription drugs to do the same. The Department of Health and Human Services’ decision will close gaps in the system by making health care more uniform and by eliminating co-payments and other fees that could deter low-income women from obtaining coverage.

The HHS plan, which is subject to change after a comment period, attempts to assuage moral concerns by including a conscience clause that would permit religious institutions offering insurance to employees to opt out of covering contraceptive services. The U.S. Conference of Catholic Bishops said the exemption was unduly narrow, would exclude most Catholic social service agencies and would end up requiring people to carry health insurance that violates deeply held moral views. This argument goes too far: Catholics and others with deeply held moral opposition to the death penalty, for example, are not thereby exempted from paying taxes. Jehovah’s Witnesses, whose religious views preclude them from having blood transfusions, do not have their religious rights violated by participating in insurance plans that provide transfusions for others.

At the same time, the new health law took appropriate steps to prevent those opposed to abortion from having to subsidize abortion coverage. Administration officials declined to discuss whether similar provisions would be workable in the context of contraception, saying only that they would examine public comments before the rule is finalized. If additional conscience protections are feasible without eroding coverage, they should be considered.

Overall, the expansion of contraceptive coverage is a smart step. It will make for healthier women, healthier children and a healthier country.