From a public health and cost standpoint, a national policy that gives women greater access to birth control only makes sense. So why is it that contraceptive coverage is shaping up as the next headline-grabbing battle over the 2010 federal health care overhaul?
The oral birth control pill has been available for 50 years. Millions of women have used it safely and effectively. Most employer-provided insurance, including the federal government's, already provides coverage for leading prescription contraceptive methods. So does Medicaid, the federal-state medical program for the poor. Yet federal regulators have nonsensically left it up in air whether the Pill and other birth control methods will constitute "preventive care" for women as the Affordable Care Act rolls out.
There's a lot riding on whether contraception will be included in the landmark definition of preventive care that's expected to be revealed by the U.S. Department of Health and Human Services (HHS) next summer. If it is -- as it should be -- it will be added to the limited list of medical procedures, such as childhood immunizations and mammograms, that are deemed so critical to public health that insurers in all 50 states will have to cover them without a copay.
If contraception does not make the list, it's likely that many insurers will continue covering it while requiring ever-growing out-of-pocket contributions. That status-quo policy would deter women from using contraception and cause more unintended pregnancies. Studies have shown that even small cost-sharing requirements can dramatically reduce the use of needed preventive care, especially among lower-income Americans, according to a 2010 policy review from the Guttmacher Institute, a nonprofit focusing on reproductive health research, education and policy analysis.
Reducing unintended pregnancies should be the common ground between prochoice and prolife groups. While Planned Parenthood is campaigning for birth control's inclusion in preventive care, some prominent conservative and prolife groups are raising objections. The U.S. Conference of Catholic Bishops has filed its concerns with the HHS. "Preventive care should be about preventing disease," spokeswoman Deirdre McQuade told the Washington Post. "Fertility is not a disease to be cured, and the government should not treat it as that."
These groups, sadly, are working against the best interests of children and mothers. Unintended pregnancies are at greatest risk for abortions. Such mothers who do carry their children to term are less likely to get prenatal care and more likely to drink alcohol or smoke, putting the child at greater risk of premature birth, low-birth weight and other developmental complications that can exact a lifetime toll. They're also costly to care for -- hospitalization alone for preterm and low-birth weight infants has been estimated at $5.8 billion a year.
The costs of providing contraceptive coverage are minimal in comparison. In fact, one prominent business group has estimated that it costs employers more not to provide birth control coverage, when accounting for direct and indirect costs such as employee productivity. Arguments that "free" birth control will send premiums soaring simply aren't supported by research.
It's hard to imagine anything that more closely hews to the definition of preventive medical care than birth control. Common sense-- not narrow, misguided rhetoric -- should guide federal officials making this important decision.