By Rebecca Adams, CQ HealthBeat Associate Editor

August 1, 2011 -- Starting Aug. 1, 2012, private health plans will have to offer free preventive services—including contraception, breast feeding supplies, and screening for sexually transmitted diseases.

The move was widely anticipated after the nonpartisan Institute of Medicine (IOM) issued a report July 19 recommending that preventive services for women be covered at no charge.

U.S. Department of Health and Human Services (HHS) officials issued an interim final rule on Monday that incorporates those recommendations. The public has 60 days to comment.

The rule would require insurers to offer free care for plan years that start on or after Aug. 1, 2012. Because many plans are based on calendar years, in practice a significant number of people will get the coverage beginning Jan. 1, 2013.

In a move that seemed designed to blunt some criticism from religious groups, faith institutions that offer insurance to their workers will be able to choose whether to cover contraception. HHS officials said they “welcome comment on this policy.” Advocates and lawmakers on both sides of that question were quick to offer their opinions on that provision.

HHS officials said Monday that the new regulation will have a “very small impact on premiums,” although they did not specify a dollar amount. They said that about 34 million women between the ages of 18 and 64 will be affected in 2013.

The free coverage will include: FDA-approved contraception and contraceptive counseling; human papillomavirus testing for women who are 30 years old and older; counseling regarding sexually transmitted diseases; human immunodeficiency virus (HIV) screening and counseling; breast feeding supplies and counseling, including rental costs for breast pumps soon after giving birth; domestic violence screening and counseling; gestational diabetes screening for pregnant women; and annual gynecological check-ups.

Insurers will still be able to charge copays for brand-name drugs if an FDA-approved generic alternative is available for free.

“These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” said HHS Secretary Kathleen Sebelius.

The leader of America’s Health Insurance Plans, Karen Ignagni, didn’t specifically criticize Sebelius for largely adopting the IOM report. Instead she went after the Institute’s recommendations.

“Unfortunately, the preventive care coverage recommendations recently issued by the IOM would increase the number of unnecessary physician office visits and raise the cost of coverage,’’ Ignagni said in her statement. “The IOM’s recommendations would broaden the scope of mandated preventive services beyond existing evidence-based guidelines, suspend current cost-sharing arrangements for certain services, and encourage consumers to obtain a prescription for routine supplies that are currently purchased over-the-counter.

“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,’’ Ignani said, referring to another rule that’s expected to be published this fall.

Controversy over Contraception
The conscience clause that allows religious groups to choose whether or not to cover contraception drew complaints from both the political left and the right.

Left-leaning advocacy groups for women praised the overall rule, but said that allowing religious institutions to refuse to cover birth control was unnecessary and potentially harmful. Some on the right said that HHS should have allowed a broader range of employers, not just those representing religious institutions, to opt out of contraceptive coverage.

The opt-out provision “was not recommended by the IOM committee,” said Debra L. Ness, president of the National Partnership for Women and Families. “Every employer should be required to provide coverage for this basic preventive care, which is essential to women’s health. Allowing some employers to refuse to do so would create barriers that, for some women, may prove insurmountable.”

Jeanne Monahan, director of the Family Research Council’s Center for Human Dignity, said that the rule “offered a fig leaf of conscience protection for certain churches that fulfill very specific criteria. However, religious groups that provide social services, engage in missions work to people of different religious faiths, religious health insurance companies, let alone religious health care providers and individuals in such health plans are not protected from any discrimination whatever.”

Janice Shaw Crouse, a senior fellow for the conservative group Concerned Women for America, said that she does not support the overall rule but offered what she called “guarded praise” for the conscience clause allowing religious groups to opt out of covering contraception.

“Why not have others opt in? It’s always people with deeply-held religious or philosophical beliefs who have to opt out,” said Crouse. “It’s an inconvenience and burden that should not be there.”
Of the overall rule, “It’s another invasion into people’s private lives and another expansion of government.”

Crouse also said that requiring insurers to offer free contraception is unnecessary.

“Poor people in this country spend their money on the latest version of cell phones, big screen TVs, cars, refrigerators. Their kids even have cell phones,” she said. “Poverty in the U.S. is not the issue that people tend to think it is. It’s a spending habits problem so I’d question whether there’s a need to pay for contraception. Today it costs practically nothing. To say that they need help with contraceptives when they have money to spend in other directions is hardly logical.”

The IOM had not recommended covering the abortion drug RU-486, and HHS officials did not include that in the list of benefits.

For emergency contraception, such as the Plan B or Ella morning-after pills, women would have to get a prescription from a doctor to be able to get it for free. The pills are also available over the counter.
Democrats on Capitol Hill largely applauded the agency’s action.

Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin, D-Iowa, said that “eliminating cost sharing for these crucial preventive services will make needed care more accessible and will improve the health of millions of women.”

Rep. Louise M. Slaughter, D-N.Y., said the rule “represents a historic milestone for women’s health and women’s rights in America. Access to contraception, counseling for victims of domestic abuse, and preventative screenings for HIV and other diseases will empower women to reduce unintended pregnancies and better protect themselves and their health. For years we’ve fought to get contraception covered for women by health insurance, just as they have covered Viagra for men.”

The regulation was issued by the departments of Treasury, Labor, and Health and Human Services.

Rebecca Adams can be reached at [email protected].