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Health Law Brings Access to More Contraceptives, But Coverage Gaps Remain, Advocates Say

By John Reichard, CQ HealthBeat Editor

April 29, 2014 -- The health care overhaul law is giving teens access to a wider range of contraceptive products that will strengthen efforts to prevent unwanted pregnancy among young people, advocates say.

After a period of interpreting the law's requirement for contraceptive coverage too narrowly, insurers have begun to cover a wider range of products including expensive intrauterine devices, speakers at a forum on preventing teen pregnancy in the District of Columbia said.

But gaps remain in coverage, said Athena Cross, a director of health reform implementation at the Planned Parenthood Federation of America. Contraceptive patches and rings often aren't covered, she said. And the law (PL 111-148, 111-152) won't fulfill its potential without efforts to encourage teens to talk to their doctors about their contraceptive options.

Doctors themselves need to be educated about the range of available products, said another speaker, Brenda L. Gleason, a professor of health policy and health communication at the George Washington University School of Public Health. Gleason also has her own consulting firm and acts as a consultant to Planned Parenthood.

Planned Parenthood clinics have long been relied on by women and teens as a source of counseling on contraceptive products and as a place to get birth control pills on the spot on a confidential basis.

Despite the ongoing controversy and Supreme Court challenges over forcing employers to cover contraceptives in their health plans, most Americans appear to support the health law's contraceptive coverage mandates.

Asked about for-profit companies whose owners object to birth control on religious grounds, 55 percent of adults in a new poll by the Kaiser Family Foundation said they should still be required to cover contraception. And 61 percent backed the health law requirement that private plans be required to cover prescription birth control without cost-sharing.

Family planning advocates emphasize that countries with wide access to contraception are more prosperous economically because women are better able to become educated and get better jobs.

Cross also made that point concerning U.S. teens at the forum sponsored by the D.C. Campaign to Prevent Teen Pregnancy. The campaign is a nonprofit charity that aims to cut the teen pregnancy rate in the District by 2015.

In particular, she emphasized the importance of "long acting reversible contraception," which can last for years and is proving to be an increasingly popular and effective way to prevent pregnancy.

The health law includes contraceptives among the preventive care that insurers must provide without charging out of pocket costs to patients.

At first insurers skimped on coverage, said Cross. "We had health plans that said okay, we're going to cover this one oral contraceptive and we're going to say that this one product satisfies the entire regulation for contraceptive coverage," she said.

But advocates put pressure on the Department of Health and Human Services to work with plans to cover more products. That's led to more coverage IUDs and intrauterine contraceptives. "We've experienced huge uptake of IUDs," which are one type of long acting contraceptive and are very expensive, said Cross.

"I think it's really important in the teen population," she added. "Previously a lot of providers felt like IUD and IUCs should only be used for women who have already had children who are older. But there's nothing to prevent younger people from having access to long acting reversible contraceptives."

Because users don't have to take any specific action for these products to work, they do a better job of preventing pregnancies, their supporters say. But they haven't escaped the abortion controversy. Groups opposed to abortion say that IUDs can lead to abortions, a contention that Planned Parenthood disputes.

Gleason said doctors often aren't up to date on long acting contraception.

She said those seeking to prevent teen pregnancy can take brochures to doctor's offices to better inform physicians about available options. And teens and their parents can be given checklists for when they talk to the physician about contraceptive options. For example, a teen can be counseled to say "'Oh I heard about this thing Obamacare. I heard a lot of stuff is free. Is this free? This free? So giving them those kinds of checklists,'" Gleason said.

But Cross said coverage still isn't what it should be.

"It's still very much left up to the health plans to determine what will be covered," she said. "Furthermore, not every plan has to cover these things," she added, noting that some insurance plans have "grandfather" status under the health law and aren't subject to all of its coverage requirements.

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