Birth Control, No Co-Pays: Why Hysteria?

Illustration for article titled Birth Control, No Co-Pays: Why Hysteria?

This week the Department of Health and Human Services announced that health insurers will be required to cover preventive care without charging a co-payment, co-insurance or a deductible. The new guidelines, which expand on preventive care already covered under the Affordable Care Act, comprise a range of services for women. These include screening for gestational diabetes, human papillomavirus (HPV) testing, HIV screening, breast-feeding supplies and support, and domestic violence counseling — but most attention has narrowly focused on the controversial addition of contraceptives.


Starting next August, new insurance plans must also cover all FDA-approved contraceptive methods — when prescribed by a health care provider — such as birth control pills, injections and implanted devices. Even before HHS announced the guidelines, backlash was swift. When the Institute of Medicine recommended free coverage of prescription birth control last month, many commentators voiced objections.

Fox News host Bill O'Reilly contended that the measure would never work. "Many women who get pregnant are blasted out of their minds when they have sex," he said. "They're not going to use birth control anyway."

Greg Gutfeld, also of Fox News, offered this argument: "If you're talking about free birth control, who's going to use free birth control? The people who can't afford it. So the left has figured out a way to eradicate the poor!"

But since the government adopted the IOM recommendations, the rants have moved to the chambers of Congress. Speaking on the House floor on Tuesday, Rep. Steve King (R-Iowa) warned of the ominous consequences of birth control without co-pays. "If you applied that preventative medicine universally, what you end up with is — you've prevented a generation," he said. "Preventing babies from being born is not medicine. That's not constructive to our culture and our civilization. If we let our birth rate get down below replacement rate, we're a dying civilization."

HHS Assistant Secretary for Health Howard Koh, however, says the issue isn't all that divisive. He talked to The Root about cutting through the hysteria and why preventive-care services without co-pays is particularly good news for women of color.

1. The inclusion of contraception isn't that revolutionary.

"Contraceptive coverage has been standard practice for most insurance plans at the state, national and federal levels, for many years in some 28 states," said Koh, playing down the reaction from some conservative members of Congress. "This announcement really builds on these past efforts."


He adds that the IOM based its recommendations on the highest levels of medical science, recognizing that being able to control one's fertility is an important part of staying healthy. "The Institute of Medicine is an internationally respected organization that advises on health policy," he said. "We endorsed their recommendations because we understand that women serve as primary health decision makers for their families. This is about getting women the preventive services that they need and deserve."

2. Affordable preventive care may mean fewer health disparities.

Several of the other areas to be newly included under preventive services, such as gestational diabetes, HPV and HIV, are more acute among black women. According to the Centers for Disease Control and Prevention, African-American women have higher rates of gestational diabetes than white women, are the most likely out of all groups to die of cervical cancer (a disease primarily caused by HPV) and have higher rates of HIV infection than women of other ethnicities.


In addition, black women are by far the least likely to breast-feed, with only 40 percent of black mothers having ever done it. "Many new moms intend to breast-feed and run into barriers," said Koh. "This new provision helps moms who want to breast-feed, and especially helps their kids get off to a healthy start in life."

3. The "Everyone else will have to foot the bill" argument is exaggerated.

In the face of complaints that providing contraceptives without co-pays will unfairly make premiums rise on everyone, Koh again points to the fact that most insurance plans already cover them to some degree. "Because many plans already cover these services, we project the rise in premiums to be very minimal," he said. "But also, the role of health plans is to offer a range of services to be accessed by many people. It's the nature of their business to offer services that are not utilized by everyone."


Finally, Koh stressed that more women will save lots of money in out-of-pocket costs. "Throughout the whole range of preventive services, we have seen that co-pays and cost represent a real barrier to access," he said, adding that women generally have more, unique medical needs than men but typically have lower incomes. "By removing the cost barrier, we improve the public health and quality of life for women."