Insurers on health exchanges likely will have to cover birth control. Report: Cover birth control

The Institute of Medicine has released its highly anticipated report on preventive services for women — and it has recommended all FDA-approved birth control methods and emergency contraception be covered by insurance companies with no cost-sharing. Companies who want to sell insurance on the exchanges will likely have to cover these services, if HHS Secretary Kathleen Sebelius includes the IOM recommendations in her final regulation.

No cost sharing preventive care is a part of the essential benefits package as required by the health care law. Stakeholders were particularly interested to see if the report would include coverage for all methods of birth control as a “preventive service.” Sebelius is due to make her decision Aug. 1.


“I want to thank the Institute of Medicine for providing this important report recommending additional preventive services for women’s health and well-being. This report is historic,” Sebelius said in statement. “Before today, guidelines regarding women’s health and preventive care did not exist. These recommendations are based on science and existing literature and I appreciate the hard work and thoughtful analysis that went into this report.”

She said the department is reviewing the report “closely” and will make recommendations “very soon.”

“This will cover current gaps in existing guidelines,” said Adam Sonfield, a senior public policy associate at the Guttmacher Institute. “This is going to have an important impact on health and well-being of women at all stages of their lives. This will level a playing field for women who cannot afford more expensive, longer lasting forms of contraceptives and allow for a choice of methods that works best for them. This will improve effective use of contraception and prevent unplanned pregnancies.”

The report also recommends complete insurance coverage — without co-pays — for lactation counseling and equipment, domestic violence screening and counseling, screening for gestational diabetes, human papillomavirus testing as part of cervical cancer screening for women over 30, counseling on sexually transmitted infections, and counseling and screening for HIV.

But abortion opponent groups argue the recommendations go too far and will violate the “conscience” of those providers, who for religious beliefs, oppose artificial forms of birth control. They argue consumers who do not wish to have their insurance plans include birth control, and emergency contraceptives will not have the choice to opt out. Finally, they say certain forms of emergency contraceptives have “chemically abortive properties.”

“We urge HHS to have these recommendations be about preventing diseases not about ending pregnancies,” said Americans United for Life counsel Anna Franzonello. “We believe that Americans who oppose these drugs should be able to choose an insurance plan that does not cover them.”

Franzonello said the IOM report included no provision for a “conscience clause.”

“This is such a broad attack on conscience rights. Even states that mandate contraception have conscience provisions,” she said, referring to insurance coverage mandates which vary from state to state.

Groups like Planned Parenthood, who testified at the IOM hearings and supported the recommendations, have a “huge financial stake in these drugs and that conflict was not disclosed” to the panel, Franzonello argued.

Planned Parenthood applauded the report and said it was “sound and based in a great deal of public health evidence.”

“Emergency contraception is not an abortion causing drug, it prevents fertilization,” said Dr. Vanessa Cullins, vice president for medical affairs at Planned Parenthood.

“This report, and the Patient Protection and Affordable Care Act, helps to move this country in a direction where we value prevention and not just acute care. And that is what we value at Planned Parenthood,” she said.

The IOM says its recommendations were made based on “a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services.”

One panel member, Dr. Anthony Lo Sosso of the University of Illinois, dissented to the recommendations. A lack of time prevented the committee from fully reviewing all the evidence and decisions were made based on politics rather than science, he said.

“The view of this dissent is that the committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee’s composition. Troublingly, the process tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy,” he wrote in a dissenting opinion.

This article first appeared on POLITICO Pro at 3:21 p.m. on July 19, 2011.