Debate to make birth control free for insured a question of prevention versus conscience rights
On Wednesday, the Institute of Medicine will announce its recommendations about preventative health-care services for women to help the U.S. Department of Health and Human Services determine which services are considered “preventive” for women’s health under the health care reform law, the Patient Protection and Affordable Care Act. Services given the “preventive” distinction will be provided at no cost under all health insurance plans associated with the law. A recommendation on one preventative care issue in particular has stirred up debate — that being contraception.
Depending on which way the Institute rules, for insured women, hormonal birth control would be essentially free.
That would have made a big difference for Andrea Leyva, of Tucson, Ariz. A few years ago, following the cancer death of one of her three children, she and her husband — both employed and with health insurance — were nonetheless struggling to pay the bills for them and their remaining two children.
The $25 copay for her monthly birth control prescription “began to fall into the category of a luxury for us,” she said, and they stopped filling the prescriptions regularly. At age 36, Leyva found herself pregnant with what she calls her “blessed surprise,” daughter Alexandria. “So while we’re happy that she’s here, it was not planned, and had we had some better finances, we probably could have made some better decisions,” Leyva says now.
According to the Guttmacher Institute, nearly half of U.S. pregnancies are unintended. One Guttmacher study (pdf) showed that in 2001, the unintended pregnancy rate was 51 per 1,000 women ages 15-44, a rate that had remained unchanged since 1994. Additionally, 22 percent of all pregnancies (excluding miscarriages) end in abortion.
It’s this last statistic that’s frequently used by abortion-rights groups such as the Guttmacher Institute and NARAL Pro-Choice America to promote birth control use as a way to prevent unintended pregnancies and, in turn, abortion. NARAL recently created a petition to encourage the Obama administration to adopt contraception as a no-cost preventive service. The organization has also created a Facebook application that shows how much women would save if they did not have to pay for the cost of contraception.
Step one of the application is to choose the person who would be taking birth control, then her age, how many kids she has, followed by her choice of birth control –- patch, pill, shot, implant, vaginal ring, cervical cap, diaphragm, IUD. Finally, the app generates how much the woman in question would save.
For example, if “your wife” is 30, has one child and is using the “birth control implant,” you and your wife can save $2,856, according to the NARAL application, and with that money, “pay for all your utilities for six months.”
However, NARAL is not the only group trying to influence the selections before the Department of Health and Human Services makes the final decision by Aug. 1. The debate has also focused on whether contraception will include “emergency contraception,” or the “morning-after pill,” which many in the anti-abortion rights community equate with abortion.
Influential policy group and law firm Americans United for Life (AUL) released a blog post Tuesday, arguing that requiring all insurance plans to cover contraception would hinder conscience-protection rights for insurance-plan recipients opposed to abortion and would likely mean “more money for Planned Parenthood.” Last July, when HHS announced it would be developing guidelines on “evidence-informed preventive care and screening” for women and tasked the Institute of Medicine to make its recommendations, AUL issued a written comment to HHS, part of which read: “It would be inappropriate to require group health plans and health insurance issuers to cover elective abortions or abortifacients, including the recently-approved drug ella.”
This notion that the two morning-after pills approved by the Food and Drug Administration, ella and Plan B, induce abortions and thus are “abortifacients,” is perpetuated by many anti-abortion groups such as Medical Students for Life of America and the Family Research Council. An FRC director recently told NPR that these drugs can cause early abortions by preventing the implantation of fertilized eggs into the uterus.
The American Congress of Obstetricians and Gynecologists (ACOG) counters this claim, stating on its website that most commonly used forms of birth control, such as those containing only the hormone progestin, “are thought to prevent pregnancy mainly by preventing ovulation. They will not work if you are already pregnancy and will not affect a pregnancy that has started.” Emergency contraceptive pills that contain estrogen and progestin, “taken in higher-than-usual amounts” than regular birth control pills, are also thought to work by preventing ovulation, according to ACOG.