Andrea Cecconi had grown accustomed to paying $50 a month for birth control pills.
It was not an unmanageable sum -- but at age 32, with a car payment and student debt to pay off, she watches every dollar. So when she discovered recently that her co-pay was gone and birth control was fully covered by her insurance, she was elated.
"For some women, that will be a lot of money," Cecconi said. "For me to not have that burden every month is wonderful.''
Cecconi had discovered the latest provision of the 2010 Affordable Care Act -- also known as Obamacare -- that requires insurers to cover a broad range of women's preventive health care without co-pays or deductibles. The rule, which formally took effect in August but is phasing in gradually, is another example of the law's sweeping effort to move American medicine in the direction of more preventive care. Soon it will cover many as 900,000 women in Minnesota, according to federal estimates.
The provision, like the law itself, is not without critics. It was contested last summer by some church-affiliated organizations, which voiced religious objections to covering birth control for their employees. President Obama struck a compromise by giving the groups an extension on the coverage.
Others object to government meddling in the economics of health care.
"Medically, I think, everyone should get a yearly exam, but there are cheaper ways of doing it," said Dr. Kenneth Crabb, an OB-GYN who practices in St. Paul and Eagan. He said he expects the law to increase the number of patients who come to him for wellness exams and birth control, but points out that someone will have to foot the bill.
Many doctors and clinic administrators expect it to raise the number of women who use birth control, expand the reach of preventive services and reduce the number of unwanted pregnancies.
"This is probably the best advance for women in a generation," said Sarah Stoesz, president of Planned Parenthood Minnesota, North Dakota, South Dakota. "For women who are in their first jobs or not making a lot of money, the co-pay and deductible can be a significant deterrent that prevents them from accessing birth control, often with life altering consequences."
Already, Planned Parenthood clinics are seeing a slight increase in women making appointments for family planning.
A study released last month by the Washington University School of Medicine in St. Louis found that women who were given access to free birth control chose more reliable methods, such as intrauterine devices (IUDs) or under-the-skin hormone implants.
Co-pays were common
In addition to prescription birth control, the new rule removes co-pays for annual Pap smears, testing for the human papilloma virus, breast feeding supplies, domestic-violence counseling and other services. Women who have health insurance but low discretionary income will benefit the most from this provision, Stoesz said.
While many insurance plans in Minnesota already covered birth control, very few offered it without a co-pay, said Eileen Smith of the Minnesota Council of Health Plans.
But the law is complex, so many patients may find the new rules confusing. Coverage for most insured women does not start until their plans renew for annual enrollment. In addition, about half of all insurance plans in the U.S. are "grandfathered,'' according to one recent study, meaning they don't have to offer the new coverage until they make other changes such as different premiums or covered benefits. The Women's Law Center predicts that by 2014 about 90 percent of all large U.S. company plans will no longer be considered grandfathered.
When Cecconi called her insurance company to find out when the provision would kick in for her, she was told she would still have to pay for her birth control because her brand was not covered. Cecconi knew that all prescription birth control pills were covered, so she held her ground.
"Once I pushed back, they went and did some research. I was surprised that at that point they did not know what was going on," Cecconi said.
Some insurers also object to the new provision, Smith said, because it limits the range of policies they can offer.
"Companies like having as many choices as possible," Smith said. "This reduces the number or types of products they can sell."
On the other hand, Smith said, consumers tend to support the provision if they, or someone close to them, benefits from it.
Cecconi is certainly one.
"When these [issues] are talked about, no one is really watching the news and thinking, 'Oh this is going to benefit me,' " Cecconi said. "It wasn't until I talked to my doctor, and she told me to look out for this that it really hit home."
Alejandra Matos • 612-673-4028 Twitter: @amatos12