Free birth control under health care?
As health reform regulations begin to take shape, Planned Parenthood has begun a quiet campaign to ensure that birth control is counted among the free preventive services that health insurers must cover under the Affordable Care Act.
Birth control barely came up in the health care reform debate, brushed aside by the more heated debate over abortion language and coverage. But with numerous religious groups opposed to contraceptive use, this issue is all but certain to become a flash point as implementation moves forward.
“We see this as a tremendous opportunity to get no-cost birth control in the bill and ensure that this part of women’s health is covered under preventive health,” said Laurie Rubiner, Planned Parenthood’s vice president of public policy.
Beginning Sept. 23, six months after the reform law passed, many health insurance plans will be required to provide free preventive services coverage, with no co-pays or out-of-pocket costs. During the reform debate, Sen. Barbara Mikulski (D-Md.) added an amendment that specified guaranteed “additional preventive care and screenings” specific to women’s health would also receive coverage.
What remains to be determined is what will make the “preventive services” list. For women’s health specifically, the Health Resources and Services Administration has been tasked with drawing up “comprehensive guidelines” on services to be included.
With little fanfare, Planned Parenthood has begun laying the groundwork for a birth control campaign that will ramp up in coming months. On The Pill Is Personal, a website launched in May to celebrate the pill’s 50th anniversary, the group is soliciting stories from birth control users. “In the coming weeks,” the site tells visitors, “federal officials will consider measures that will dramatically increase access. Share your story or comments about how the pill changed your life and how it can change others.”
The women’s stories may soon be used to lobby federal agencies on birth control’s importance.
“This needs to be based on science and medical evidence, but ... it is also really important to hear the stories of how women view birth control, the health impact and the affordability issue,” Rubiner said.
Planned Parenthood has other plans in the works, too. It might soon tap young adults, particularly those who have had their dependent coverage extended up to age 26, who are curious about what benefits they will receive. “Certainly, we have a very large, grass-roots organization interested in making an impact,” Rubiner said. “It’s a very tangible thing for women and something they will really support.” College campuses, too, could be fruitful territory for reproductive rights activism.
Other reproductive health groups are also at work on the issue, looking at whether emergency contraception could find a place under the new regulations. “We’re in a collation, operating on the same tasks within our community,” said Laura MacCleery, director of government relations for the Center for Reproductive Rights. “We’re actively pursuing what we think falls within the appropriate boundaries of the coverage of this amendment.”
The groups have at least one big supporter: Mikulski, who intended her amendment to cover birth control as preventive care. “Her intention was to have preventive services provided for women at no additional cost, no deductibles,” Mikulski spokeswoman Rachel MacKnight said. “From her perspective, that includes everything from heart disease screening and diabetes screening to mammograms to birth control.”
Predictably, not everyone is celebrating the groups’ work. The U.S. Conference of Catholic Bishops, for example, opposes categorizing birth control among preventive services.
“Congressional debate on the need to cover ‘preventive services’ in health care reform centered on services needed to prevent life-threatening diseases like breast cancer, not on a need to prevent the birth of new recipients of health care,” Richard Doerflinger of the conference’s Secretariat for Pro-Life Activities e-mailed POLITICO.
“Requiring contraception and sterilization in all private health plans would be an enormous imposition on the consciences of religious organizations and others who now have the right to purchase a health plan in accord with their moral and religious values.”
A representative of HRSA could not comment on whether birth control would be covered under agency “comprehensive guidelines” because they are only in initial planning phases.
“We have six months from passage to come up with that, and it’s still being worked on,” said HRSA communications director Martin Kramer.
Health and Human Services also has an eye on the process. “HHS is working through a deliberative process to develop the guidelines as called for in the statute,” said spokeswoman Jessica Santillo.
Currently, about 90 percent of employer-based health insurance plans cover prescription birth control, according to a Guttmacher Institute study. Co-pays for birth control medications can range from $10 to $50 a month, according to Planned Parenthood, depending on brand and type.
For younger and lower-income women, Rubiner said, co-pays can push birth control products out of financial reach, which makes free preventive coverage critical.
“We still have one of the highest abortion rates of developed countries,” Rubiner said. “One of the single biggest reasons is that contraception is still financially out of reach for many women.”
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