USA: Panel advises contraception coverage

A leading medical advisory panel has recommended that all insurers be required to cover contraceptives for women free of charge as one of several preventive services under the new health care law, the New York Times reports.

Obama administration officials said that they were inclined to accept the panel’s advice and that the new requirements could take effect for many plans at the beginning of 2013.

The administration signalled its intentions in January when Kathleen Sebelius, the secretary of health and human services, unveiled a 10-year programme to improve the nation’s health. One goal was to “increase the proportion of health insurance plans that cover contraceptive supplies and services.”

Administration officials, who say they hope to act on the recommendations by 1 August, are receptive to the idea of removing cost as a barrier to birth control, the New York Times reports. But the recommendations immediately reignited debate over the government’s role in reproductive health. Women’s groups and medical professionals applauded the recommendations while the Roman Catholic Church raised strenuous objections.

The recommendations came in a report submitted to Ms. Sebelius by the Institute of Medicine, an arm of the National Academy of Sciences. The new health care law says insurers must cover “preventive health services” and cannot charge for them. The panel said insurers should be forbidden to charge co-payments for contraceptives and other preventive services because even small charges could deter their use. The recommendation would not help women without insurance.

In addition to contraceptive services for women, the panel recommended that the government require health plans to cover screening to detect domestic violence; screening for HIV; and counselling and equipment to promote breastfeeding, including the free rental of breast pumps.

The panel also said all insurers should be required to cover 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.

Defending its recommendations on contraceptive coverage, the panel said that nearly half of all pregnancies in the United States were unintended, and that about 40 percent of unintended pregnancies ended in abortion. Thus, it said, greater use of contraception would reduce the rates of unintended pregnancy, teenage pregnancy and abortion.

The chairwoman of the panel, Dr. Linda Rosenstock, dean of the School of Public Health at the University of California, Los Angeles, said, “We did not consider cost or cost-effectiveness in our deliberations.” But the panel’s report says that “contraception is highly cost-effective,” averting unintended pregnancies that would be far more expensive than contraception.

To reduce unintended pregnancies, the panel said, insurers should cover the full range of contraceptive methods approved by the Food and Drug Administration, as well as sterilization procedures and “education and counseling for all women with reproductive capacity.” This recommendation would require coverage of emergency contraceptives including pills like ella and Plan B, panel members said.

The report touched off a fierce debate, the the New York Times reports. Obstetricians, gynecologists, public health experts and Democratic women in Congress hailed the recommendations. But the United States Conference of Catholic Bishops and some conservative groups, including the Family Research Council, denounced the recommendation on birth control.

Panel Recommends Coverage for Contraception. New York Times, 19 July 2011