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Panel recommends that health plans cover contraception for women without co-pays

The recommendation by a panel of doctors and health experts sets the stage for another debate about the effect of the healthcare overhaul.

July 20, 2011|By Noam N. Levey, Los Angeles Times

Reporting from Washington — An independent panel of doctors and health experts is recommending that health plans cover a variety of contraceptives for women without co-pays, setting the stage for another debate over the effect of the healthcare overhaul.

The law that President Obama signed last year requires new health plans to cover a basic set of preventive health services without co-pays or deductibles for patients, a key provision of the new law that experts believe will encourage more Americans to get recommended immunizations, cancer screenings and other services.

The law directed the U.S. Department of Health and Human Services to seek input from clinicians and other authorities about which additional services should be covered for women.

That prompted the report Tuesday from the Institute of Medicine, or IOM, a branch of the National Academy of Sciences that provides guidance to policymakers.

Among eight recommendations, the IOM panel urged coverage for "the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling."

With close to half of all pregnancies unplanned in the U.S., many experts see easy access to contraception as crucial to women's and babies' health.

Mothers with unwanted pregnancies are less likely to receive prenatal care and more likely to engage in unsafe behaviors such as drinking and smoking, according to research cited by the IOM.

The IOM report noted that contraceptive coverage is "standard practice" for most private insurance plans and federally funded insurance programs.

Health and Human Services Secretary Kathleen Sebelius called the recommendations historic and said her department would review them before it finalizes regulations "very soon" specifying which preventive services would have to be covered. A decision is due by Aug. 1.

Dr. Linda Rosenstock, who chaired the IOM panel, said the Obama administration probably would have to consider other issues beyond the scientific recommendations provided by the panel.

"Our decision was based on the evidence of what works and not what the cost of them is," she said. "These are issues that will need to be considered."

The recommendations, endorsed by all but one of the 16 IOM panel members, won praise from many women's groups but criticism from anti-abortion activists.

"Making family-planning services available at no cost will help millions of women prevent unintended pregnancy and thereby reduce the need for abortion," NARAL Pro-Choice America President Nancy Keenan said.

Anti-abortion groups objected to expanding coverage for contraception, singling out so-called morning-after emergency contraceptives such as Ella that can prevent implantation of a fertilized egg.

"A federal mandate to all insurance plans to include drugs such as Ella essentially would mandate coverage for abortion," said Jeanne Monahan, director of the Family Research Council's Center for Human Dignity.

Although the recommended coverage would include drugs such as Plan B or Ella, it would not include the controversial drug mifepristone, or RU-486, which can end an established pregnancy, said Alina Salganikoff, an IOM panel member and director of women's policy at the nonprofit Kaiser Family Foundation.

Other preventive services for women that the IOM panel recommended be covered without cost sharing include: screening for gestational diabetes; human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30; counseling on sexually transmitted infections; and counseling to detect and prevent domestic violence.

The new law already requires that mammograms for women over 40 be covered by new health plans without cost sharing.

The architects of the healthcare overhaul made prevention a major focus of the new law, driven by growing consensus among physicians and public health experts that more aggressive efforts to prevent disease could help restrain the nation's growing healthcare costs.

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