Health insurers should pay for a range of services for women at no cost, including birth control, counseling on sexually transmitted diseases, and AIDS screening, the influential Institute of Medicine recommended on Tuesday.
The recommendations on birth control especially angered anti-abortion activists, who consider some forms of birth control akin to abortion. But they are sure to thrill some Democrats on the Hill, who have been pressing for the policies for years.
The committee of experts appointed by the Institute named eight preventive services that women should get for free, with no co-pays. The Health and Human Services Department commissioned the report from the Institute, an independent organization that advises the federal government on health and medical matters.
It will be up to HHS to decide what goes into the final regulations, and Congress may decide to weigh in. "They asked for the guidance on what the evidence and science says, so that's what we've given," said Christine Stencel, a spokeswoman for the Institute.
“The eight services we identified are necessary to support women's optimal health and well-being. Each recommendation stands on a foundation of evidence supporting its effectiveness,” Linda Rosenstock, dean of the School of Public Health at UCLA, who chaired the panel, said in a statement.
Jeanne Monahan, director of Family Research Council's Center for Human Dignity, said covering birth control without a co-pay could force people who object to contraceptives to pay into a premium system that uses their money to cover the cost of others’ drugs. "We want people who have conscience issues to not be forced into a mandate that covers these drugs," Monahan said in an interview.
Some of the recommendations may also give pause to spending conservatives. One calls for fairly pricey testing for the human papilloma virus, or HPV, which causes cervical cancer, in addition to the cheap annual Pap smears that most women are used to getting. Another calls for insurers to pay for renting breast pumps for nursing mothers.
The eight recommendations include:
- screening for gestational diabetes
- HPV testing as part of cervical cancer screening for women over 30
- counseling on sexually transmitted infections
- counseling and screening for HIV
- contraceptive methods and counseling to prevent unintended pregnancies
- lactation counseling and equipment to promote breast-feeding
- screening and counseling to detect and prevent interpersonal and domestic violence
- yearly well-woman preventive care visits to obtain recommended preventive services
Paying for birth control is especially important, said the panel.
“Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy. Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems,” the report reads.
It’s also required by the first amendment to the 2010 health reform law, written by Sen. Barbara Mikulski, D-Md.
“Today’s IOM report means we are one step closer to saying good-bye to an era when simply being a woman is treated as a preexisting condition,” Mikulski said in a statement. “We are saying hello to an era where decisions about preventive care and screenings are made by a woman and her doctor—not by an insurance company, members of Congress, or a stranger—and women are guaranteed preventive screenings and care with no additional co-pays or deductibles.”
The panel said current recommendations of screening for cervical cancer, counseling for sexually transmitted infections, and HIV counseling and screening are too limited in scope and should be expanded.
"This report is historic. Before today, guidelines regarding women’s health and preventive care did not exist. These recommendations are based on science and existing literature and I appreciate the hard work and thoughtful analysis that went into this report," HHS Secretary Kathleen Sebelius said in a statement.
“We are reviewing the report closely and will release the department’s recommendations of what additional preventive services for women should be covered without cost sharing very soon."
The experts also recommended that all women and adolescent girls be screened and counseled for interpersonal and domestic violence “in a culturally sensitive and supportive manner”.
“An estimated 5 million women are physically, sexually, or emotionally abused by their partners each year in the United States. Screening for risk of abuse is central to women’s safety, as well as to addressing current health concerns and preventing future health problems,” the IoM said in a statement.
Nancy Keenan, president of NARAL Pro-Choice America, was delighted. “As someone who has worked on women’s rights for nearly 30 years, I can say that today’s news marks one of the biggest advances for women’s health in a generation,” Keenan said in a statement. “Currently, nearly one in three women finds it difficult to pay for birth control, and that’s why the United States has a far higher unintended-pregnancy rate than other industrialized countries."
But she noted that the House has voted twice this year to defund family-planning programs. "These politicians are so out of touch with our country’s mainstream values that they will try to derail the promise of no-cost birth control, and we will fight them every step of the way," Keenan said.