One of the provisions of the Affordable Care Act is a requirement that new health plans cover preventive services for women without deductibles or co-payments. The Department of Health and Human Services asked the Institute of Medicine to review what preventive services are important to women's health and well-being and make recommendations about which of these should be required to be covered without cost-sharing.
The IOM issued its report, Clinical Preventive Services for Women: Closing the Gaps, yesterday, and it focuses on the preventive services not already spelled out for coverage in the ACA (that list includes services recommended by the US Preventive services Task Force, the American Academy of Pediatrics, and the CDC's Advisory Committee on Immunization Practices). The additional preventive measures the IOM recommends meet the following criteria:
- The condition to be prevented affects a broad population;
- The condition to be prevented has a large potential impact on health and well-being; and
- The quality and strength of the evidence is supportive.
The preventive health services for women that the IOM recommends be covered by all health plans are the following:
- Screening for gestational diabetes in pregnant women
- The addition of high-risk HPV DNA testing in addition to conventional cytology testing in women with normal cytology results.
- Annual counseling on sexually transmitted infections for all sexually active women.
- Counseling and screening for HIV infection annually for all sexually active women.
- The full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.
- Comprehensive lactation support and counseling and costs of renting breastfeeding equipment.
- Screening and counseling for interpersonal and domestic violence.
- At least one well-woman preventive care visit annually for adult women to obtain the recommended preventive services, including preconception and prenatal care.
Can you guess which of these eight recommendations got the most attention, as demonstrated in the New York Times and Washington Post articles about the IOM's report? Why, yes, it's the recommendation that the full range of FDA-approved contraceptive methods be covered - methods that an estimated 99% of women who've had sexual intercourse have used, but that are opposed by an extremely small but extremely vocal segment of our population.
Here's a statement from my George Washington University School of Public Health colleague Susan Wood, PhD, who served as FDA's Assistant Commissioner for Women's Health from 2000 to 2005 - and resigned her position there after the agency repeatedly delayed a final ruling on over-the-counter sale of the emergency contraception Plan B, despite recommendations of approval by FDA's scientific staff:
Women know that preventive services for women includes family planning. Today the IOM confirmed that contraception is prevention and is part of the prevention package that should be covered by all health care plans. By reducing co-pays and deductibles for women getting contraception, this will help women and couples plan their families, space their children, reduce unintended pregnancies, and promote better health for women and children. Preventing unintended pregnancies is the best way to prevent abortion.
Women spend decades of their lives trying to prevent pregnancy, and only a few years actually trying to get pregnant and having children. Making contraception affordable by eliminating co-pays and deductibles is common sense for millions of women and couples across the country - and a real benefit that women will see immediately in their pocketbooks. This coverage of contraception will truly help "Close the Gaps" for women.
Contraception is not controversial - except sometimes for politicians. But this should not be political; coverage of contraception should be based on the evidence as outlined by IOM, which shows that contraception for women is indeed safe and effective prevention. Along with well-woman visits and critical screening for gestational diabetes, STDs, domestic violence, and other important women's health preventive services, the IOM report "Closing the Gaps" has helped ensure that women's health counts when we talk about prevention. Women should not be blocked from these critical preventive services due to cost or political debate.
The evidence on the importance of contraception and other health services for women is in. Whether women's access to these services will be improved is still an open question.