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Birth Control Set to Become More Accessible Under Health Law

July 20, 2011 at 12:00 AM EST
This week, a panel from the Institute of Medicine recommended complete coverage for birth control and FDA-approved contraception for women. Jeffrey Brown discusses what services could be covered under the health care reform law signed by President Obama last year with NPR's Julie Rovner.
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JEFFREY BROWN: Next, compelling insurers to cover contraception.

The new health care reform law that President Obama signed last year not only expands the number of people who get coverage, it also requires the secretary of health and human services to determine which preventive benefits should be provided by all insurers.

Yesterday, a panel from the independent Institute of Medicine recommended several health services, it said, women should receive without co-pays or other costs. Its most controversial recommendation: complete coverage for birth control and FDA-approved contraception.

Julie Rovner of NPR has been covering this story and joins us now.

Welcome to you.

JULIE ROVNER, National Public Radio: Nice to be here.

JEFFREY BROWN: Now, explain the context a bit more here.

So this group was charged — was asked by the government to come up with a list.

JULIE ROVNER: That’s right.

Now, the law as it passed last year wanted to encourage people who had insurance to take advantage of more preventive care. So it said that the way to do that was to basically make it free. You pay your premiums, but you don’t have to pay any co-pays or deductibles to get preventive care.

There were three categories of preventive care that were automatically covered. They were written right into the legislation, certain preventive services that were listed by the U.S. Preventive Health Services Task Force, things like mammograms and colonoscopies, certain services that were listed by the American Academy of Pediatrics for children and adolescents, and vaccines that were listed by the CDC’s vaccine category.

There was a fourth category that was listed — that came about because Sen. Barbara Mikulski from Maryland actually got an amendment added that the secretary would have discretion to add, and these would be preventive services for women, because over the years preventive services for women have thought to have been left out by the Preventive Health Services Task Force.

And those were left to the secretary’s discretion. The secretary last year decided she wanted some expert advice, so she turned to Institute of Medicine. This report…

JEFFREY BROWN: An independent group.

JULIE ROVNER: An independent group, an independent non-governmental group. This report is the result of what they have come up with.

JEFFREY BROWN: All right, so they made the recommendations and, as we said, the most controversial here is on birth control. Tell us what they’re suggesting should be covered at no cost.

JULIE ROVNER: At no cost, they’re suggesting basically all of the FDA-approved forms of contraception. So that includes birth control pills, implants, the IUD and also, most controversially, of this — somewhat controversial, although it shouldn’t be too controversial because 99 percent of women of child-bearing age use some form of contraception, including 99 percent of Catholics, we have seen in public opinion polls.

But it also does include the morning-after pill. Now, this is not the abortion pill, mifepristone, RU-486, but there are two FDA-approved morning-after pills, emergency contraceptives. One’s called plan B. One just approved last year is called Ella. There are people in the anti-abortion movement who do believe that there is a mode of action in these morning-after pills that can prevent a fertilized egg from implanting in a woman’s uterus.

They believe that that is a very early form of abortion, although the medical community doesn’t.

JEFFREY BROWN: Now, how big a change this would be? Most private insurance plans cover contraception, but have a co-pay.

JULIE ROVNER: That’s right. And that’s the change. In fact, because of a decision that was made by the Equal Employment Opportunity Commission in 2000, which found that it was discriminatory to offer prescription coverage of any sort, but not offer prescription birth control coverage, most employers do offer prescription contraceptive coverage.

But, indeed, there is a co-pay. That does stop some women, obviously most lower-income women — or it affects them most. So, it does stop some women from using contraception or using it as regularly as would be optimum. So, it’s considered. And there is considerable evidence. And that’s one of the things the Institute of Medicine looked at, that if it was available with no co-pay, not only would women be more likely to use it, but they’re more likely to use not just the birth control pill, which is relatively inexpensive, but some of the more effective, but perhaps more expensive, longer-acting forms of birth control, like the implants, like the IUD.

So that would be — they would be less likely to have unintended pregnancies. And, indeed, one of every two pregnancies in the U.S. is unintended and half of those pregnancies do end in abortion.

JEFFREY BROWN: Something the group pointed to in their report.

JULIE ROVNER: That’s right.

So if you’re against abortion, you should probably be for birth control.

JEFFREY BROWN: Well, there was a lot of reaction from both sides.

JULIE ROVNER: Yes, there was a lot of reaction from both sides.

Women’s health groups, obviously, were very pleased to see these recommendations. Those who were against them, particularly the Catholic Church and some conservative women’s groups, were very unhappy, worried about violating the conscience rights of people who will — who, as they say, will now have to pay for insurance that includes these benefits, although as you point out, most insurance policies already include these benefits.

It’s simply, will they be offered with no co-pays or will they be offered with co-pays?

JEFFREY BROWN: Now, the next step here, as we say — so, this is an independent group. It puts it out there.

Now, Kathleen Sebelius, the HHS secretary, has to consider these as part of a broader project that she’s looking at, right?

JULIE ROVNER: That’s right.

JEFFREY BROWN: Yes.

JULIE ROVNER: This is one small piece. She’s determining — first she’s going to determine whether this will be part of this preventive health package that will be made available with no co-pays, but she’s also determining these essential — what kind of things will be included in the essential benefits package.

JEFFREY BROWN: That’s the important word, right, essential?

JULIE ROVNER: That’s right. Essential benefits.

JEFFREY BROWN: Yes.

JULIE ROVNER: And there’s a balancing act that you need when you’re creating an essential benefits package, because every time you put a benefit into the package, it makes a package more expensive, it makes the premium higher. That’s going to raise the amount that the federal government will have to pay in subsidies to people who will qualify for subsidies and what everyone will have to pay in their premiums. So you don’t want to load that…

JEFFREY BROWN: Co-pays may be off, but premiums will go higher.

JULIE ROVNER: Exactly. That’s why I have been resisting using the word free for this.

JEFFREY BROWN: I see.

JULIE ROVNER: It’s not going to be free. You are just going to pay for it in your premiums and everybody else is going to help pay for it in their premiums.

JEFFREY BROWN: Well, so, just briefly, though, so that means the stakes are quite high. There’s a lot — there is a big lobbying effort going on here by all the parties?

JULIE ROVNER: There is, not so much on this as there is — because, as we have mentioned, this is mostly being covered now, and birth control pills in particular are not that expensive. But for a lot of other things, there’s a lot of lobbying going on.

Particularly, the insurance industry doesn’t want to see that essential benefits package in general get too large, because then the package as a whole will become too expensive for people to afford.

JEFFREY BROWN: All right, Julie Rovner of NPR, thanks so much.

JULIE ROVNER: You’re welcome.