New federal guidelines that will ensure women receive preventive health services, including birth control, with no out-of-pocket costs are being applauded by women’s groups as an important step toward improved health of women and children and criticized by an insurance trade group, which warns the guidelines could result in significantly higher costs for coverage.
U.S. Department of Health and Human Services announced that beginning Aug. 1, 2012, new health insurance plans would be required to cover certain women’s preventive services without charging the patient a co-payment, coinsurance or deductible for those services.
Developed by the independent Institute of Medicine, the new guidelines are part of the Affordable Care Act passed by Congress and signed into law by President Barack Obama in 2010.
“These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” HHS Secretary Kathleen Sebelius says in a prepared statement.
New services covered under the act include:
- Annual well woman visits for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care.
- Screening of gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.
- Annual counseling for sexually transmitted infections.
- Annual counseling and screening for human immune-deficiency virus for all sexually active women.
- Contraceptive methods and counseling approved by the U.S. Food and Drug Administration.
- Breastfeeding support, supplies and counseling in conjunction with each birth.
- Domestic violence screening and counseling.
Cecile Richards, president of Planned Parenthood Federation of America, calls the HHS’ action a historic victory for women’s health and women.
“The decision by HHS is monumental for millions of women who have struggled with the cost of birth control and other essential health care services such as cervical cancer and HIV screening,” Richards says.
Planned Parenthood says eliminating co-pays will help reduce unintended pregnancies, which accounts for nearly half of all pregnancies in the U.S. The organization also adds that birth control could protect women against endometriosis and reduce the risk of ovarian cancer, and allow women to plan and space their pregnancies, thereby improving maternal, infant and family health.
The organization said co-pays for birth control pills typically range between $15 and $50 per month. Other methods, such as IUDs, often cost several hundred dollars, even with health insurance.
Marcia D. Greenberger, co-president of the National Women’s Law Center, calls the guidelines a “huge step forward for fairness and improved health outcomes for women and their families.”
HHS said insurance plans will be able to retain flexibility to control costs by continuing to charge cost-sharing for brand drugs if a generic version is available and is just as effective and safe for the patient.
But Karen Ignagni, president and CEO of America’s Health Insurance Plans, a national trade association for the health insurance industry, says the new guidelines would increase the number of unnecessary physician office visits and encourage consumers to obtain a prescription for routine supplies that are currently purchased over-the-counter.
She said the IOM’s recommendations broaden the scope of mandated preventive services beyond existing evidence-based guidelines.
“Exceeding current evidence-based guidelines sets a troubling precedent for the IOM’s future coverage recommendations, including essential health benefits that will significantly impact the affordability of coverage and the cost to taxpayers,” Ignagni says.
Aetna issued a statement saying it is reviewing the new guidance to determine how it may need to revise its benefits structures, and how the additional benefit mandates may impact both care quality and costs for employers and members.
“In the end, the impact will vary based on the type of plan (individual, small group or large group) and the preventive services already covered under the plan,” Aetna states.
Judy Waxman, vice president of health care and reproductive rights for the National Women’s Law Center, says, however, that contraceptive coverage has been shown to save money in the long run, or at least not add to the cost of insurance premiums. She notes, for example, that premiums didn’t change when the contraceptive requirement was added to the Federal Employee Health Benefit Plan.
Both Planned Parenthood and the law center expressed disappointment in one area of the new guidelines. An amendment to the regulation would allow religious institutions that offer insurance to their employees the choice of whether they will cover contraceptive services.
HHS urges all women, regardless of who they work for, should have access to contraceptives without co-pays.
Nearly 99 percent of sexually active women, regardless of their religious beliefs, use contraception at some point in their lives, according to the Women’s Law Center.
