This major change in health care policy, announced by HHS on August 1, 2011, is part of a larger effort under the Obama administration's Affordable Care Act to broaden the range of women's preventive services included in health care reform. This change eliminates co-pays and cost-sharing and will assist women in preventing unwanted pregnancies and spacing births farther apart -- both key factors in optimizing maternal and fetal health.
Although contraception is the most controversial of the preventive services outlined in the new HHS guidelines, it's just one of eight no cost benefits women covered by insurance will enjoy when the policy goes into effect August 1, 2011.
The Affordable Care Act (ACA) -- signed into law by President Obama in March of 2010 -- included coverage of preventive services such as mammograms, cervical cancer screenings and prenatal care. Although the intent was to offer comprehensive care for women, coverage fell short in many areas including family planning, HIV prevention and detection, and breastfeeding support.
In an effort to identify and close these gaps, HHS subsequently commissioned the Institute of Medicine (IOM) to conduct a study to determine what additional preventive services would be necessary for women's health and well-being and should be considered in the development of a more comprehensive set of guidelines for preventive services for women.
A division of the National Academy of Sciences charged with advising the nation on health topics, the IOM's findings often guide policy-making decisions. Such was the case with their report issued July 19, 2011, recommending that eight preventive health services be added to the health care plans insurers cover at no cost to women.
Those same eight services are the basis of the new HHS guidelines:
- screening for gestational diabetes
- screening for HPV as part of cervical cancer screening for women over 30
- screening and counseling for HIV
- screening and counseling to prevent interpersonal and domestic violence
- counseling on sexually transmitted infections
- contraceptive methods and counseling to prevent unintended pregnancies
- lactation counseling and equipment to promote breast-feeding
- annual well-woman preventive care visits to obtain recommended preventive care services
IOM committee chair Linda Rosenstock, dean of the School of Public Health at UCLA, likens the group's findings to "a road map for improving the health and well-being of women." She regards the above services as "necessary to support women's optimal health and well-being" and states that each recommendation "stands on a foundation of evidence supporting its effectiveness."
Many of the preventive services are highly cost-effective and can reduce or eliminate some of the most pressing health care problems facing women and children. According to the IOM release accompanying the report's publication:
Deaths from cervical cancer could be reduced by adding DNA testing for HPV, the virus that can cause this form of cancer, to the Pap smears that are part of the current guidelines for women's preventive services....Cervical cancer can be prevented through vaccination, screening, and treatment of precancerous lesions and HPV testing increases the chances of identifying women at risk.
Although lactation counseling is already part of the HHS guidelines...comprehensive support [should include] coverage of breast pump rental fees as well as counseling by trained providers to help women initiate and continue breast-feeding. Evidence links breast-feeding to lower risk for breast and ovarian cancers...[and] reduces children's risk for sudden infant death syndrome, asthma, gastrointestinal infections, respiratory diseases, leukemia, ear infections, obesity, and Type 2 diabetes. ...
To reduce the rate of unintended pregnancies, which accounted for almost half of pregnancies in the U.S. in 2001...the full range of Food and Drug Administration-approved contraceptive methods [should be covered] as well as patient education and counseling for all women with reproductive capacity. 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.
Although pregnancy prevention is one of the goals of the new HHS guidelines, provisions will be made for those insurers who -- because of religious affiliation -- decline to cover contraceptive services.. Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, will be exempt.
"Birth Control Guide." US Food and Drug Administration, FDA.gov. 26 July 2010.
"Federal health department approves free birth control." Your Life at USAToday.com. 1 August 2011.
------- "IOM Report Recommends Eight Additional Preventive Health Services to Promote Women's Health."Office of News and Public Information, NationalAcademies.org. 19 July 2011.
Pereira, Jennifer and Kevin Dolak. "Birth Control Free for All: New Insurance Rules Affect Millions of Women." ABC News/Health at abcnew.go.com
Reinberg, Steven. "HHS: Insurers Must Pay for Birth Control for Women." US News Health at health.usnews.com. 1 August 2011.
"Women's Preventive Services: Required Health Plan Coverage Guidelines." US Department of Health and Human Services, Health Resources and Services Administration, HRSA.gov. Retrieved 2 August 2011.