The fact that the Institute of Medicine recommended that insurance plans cover all birth control for free, with no deductibles or co-pays, is definitely a big deal. The IOM recommendations are not binding, but they were requested by Health and Human Services Secretary Kathleen Sebelius to guide her determinations of essential benefits to be covered for insurance companies going forward. So the recommendation should carry a lot of weight. This is part of the free preventive services portion of the Affordable Care Act, an overlooked piece of the law. Free birth control would be a boon to family planning policy, reduce the abortion rate and provide an essential complement to public health. Sebelius praised the IOM recommendations, suggesting that she will adopt them.

Many states already mandate birth control as part of health insurance coverage, but this would federalize that standard, and extend it to poorer women by making it free.

The Guttmacher Institute has a good report on the implications of this decision:

Significantly, the IOM recommendations also include the “full range of Food and Drug Administration–approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.” The IOM considers these services essential so that “women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes.”

Making contraceptive counseling, services and supplies—including long-acting, reversible methods (the IUD and the implant), which have high up-front costs—more affordable acknowledges the reality that cost can be a daunting barrier to effective contraceptive use. The evidence strongly suggests that insurance coverage of contraceptive services and supplies without cost-sharing is a low-cost—or even cost-saving—means of helping women overcome this obstacle.

There are additional recommendations from the IOM, including an annual well-woman preventive care visit, counseling and screening for HIV and domestic violence, and early detection for reproductive cancers (like cervical cancer) and STDs. The morning after pill would be included in this package as well.

Given the lapses in time from HHS for public comment and the rest, this probably won’t become a feature of insurance plans until January 2013. Expect to hear a lot of bleating from the forced-birth lobby between now and then. This will expose them as not making principled decisions about human life, but just against women having control of their bodies and their pregnancies. It’s about control.

David Dayen

David Dayen

1 Comment