Is contraception part of preventive health?
As of September 2010, federal health reform legislation will require all new private health plans to provide coverage of a slate of preventive health services at no cost to patients. Will contraception be included in that coverage? Reproductive health advocates are calling for such measures.
While many health plans already cover prescription contraceptives, women face challenges when it comes to insurance co-payments. Co-payments may be set at up to $50 per month for birth control pills to several hundred dollars for a longer-acting method such as an intrauterine device.1 Twenty-seven states have laws that require insurers include some level of contraceptive coverage in their plans.2
By including contraceptive services under preventive care, the United States could move forward in reaching its goal of decreasing unintended pregnancies to 30% by 2010. Such efforts are needed. Statistics indicate approximately one-half of all pregnancies in the United States were unintended in 2001, the last year for which data is available.3 Unintended pregnancy is associated with an increased risk of morbidity for women, as well as with health behaviors during pregnancy that are associated with adverse effects. Unintended pregnancies carry a high economic cost as well: The direct medical costs of unintended pregnancies in the United States were estimated at $5 billion in 2002.4
For contraception to be included under the new legislation, the Department of Health and Human Services (HHS) requires an official interpretation of the legislation's requirement and of the specific preventive services it requires. The Health Resources and Services Administration (HRSA), which falls under HHS, is contracting with the Institute of Medicine to review supporting data regarding contraceptive services, says Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center in Washington, DC.
The institute will take a comprehensive look at the subject, weigh the evidence, and will issue its findings to HRSA, says Waxman. While similar data reviews have taken up to three years, findings may be released to HRSA more rapidly, perhaps in nine months to a year, Waxman states. The accelerated timeline is projected given that the health care reform legislation goes into effect September 2010, says Waxman.
In 2007, the Washington, DC-based National Business Group on Health, a membership group for large private- and public-sector employers, recommended that all employer-sponsored health plans include comprehensive coverage of unintended pregnancy prevention services, free of any cost-sharing, as part of a recommended minimum set of benefits for preventive care.5 By including the full range of prescription contraceptive methods, sterilization services, lab tests, counseling services, and patient education to a plan that currently includes no coverage at all, estimates indicate costs at about $40 per member per year.
Even putting aside the fact that the $40 annual figure does not account for the likely cost-savings from contraceptive coverage, such a figure is "miniscule" when compared with overall insurance premiums, says Adam Sonfield, Guttmacher Institute senior public policy associate. Annual average premiums are more than $4,800 for an individual employee and nearly $13,400 for a family, according a 2009 study from the Kaiser Family Foundation.6
If plans could offer coverage of contraceptive services, counseling, and supplies without cost sharing, several benefits could be achieved, according to a 2010 Guttmacher Institute analysis.7 These include closing gaps in insurance coverage, reducing the disincentive to seeking care that even modest cost sharing can pose, and enhancing effectiveness of contraceptive use.
"It simply makes eminent sense to ensure that family planning services are comprehensively integrated into preventive care," says Sonfield. "This must include coverage for the full range of contraceptive drugs and devices, related services such as insertion and removal of devices, and counseling and patient education."
Contraceptive provision qualifies as a preventive service under the current legislation, says Waxman, as it represents a public health issue in terms of women being able to prevent unintended pregnancies for their health and for the health of future children.
"It fits," states Waxman. "It's going through the process it needs to, and we're hopeful" it will be included in preventive coverage.
References
- Andrews M. Health insurers may soon offer contraceptives at no extra cost. Washington Post, July 6, 2010:HE05.
- Guttmacher Institute. Insurance Coverage of Contraceptives. Accessed at www.guttmacher.org/statecenter/spibs/spib_ICC.pdf.
- Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006; 38:90-96.
- Trussell J. The cost of unintended pregnancy in the United States. Contraception 2007; 75:168-170.
- Campbell KP, editor. Investing in Maternal and Child Health: An Employer's Toolkit. Washington, DC: Center for Prevention and Health Services, National Business Group on Health; 2007.
- Claxton G, DiJulio B, Whitmore H, et al. Job-based health insurance: costs climb at a moderate pace. Health Aff (Millwood) 2009; 28:1,002-1,012.
- Sonfield A. Contraception: an integral component of preventive care for women. Guttmacher Policy Review 2010; 13:2-7.
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