HHS Issues Rule on Coverage of Contraception and Other Women's Health Services

I wrote last month about the Institute of Medicine recommendations regarding preventive health services for women that should be covered by all new health plans without requiring co-payments or other cost sharing. Like many other supporters of women's health, I was especially interested in the proposal that contraceptives be covered at no charge to women. So, I was happy to hear that the Department of Health and Human Services has released a rule that accepts all of the IOM's recommendations.

Here's the list of preventive services that private health plans will have to start covering without cost sharing in plan years beginning on or after August 1, 2012:

• Well-woman visits
• Screening for gestational diabetes
• Human papillomavirus testing
• Counseling for sexually transmitted infections
• Counseling and screening for human immune-deficiency virus
• Contraceptive methods and counseling ("All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity")
• Breastfeeding support, supplies, and counseling
• Screening and counseling for interpersonal and domestic violence

Eliminating cost sharing for these services will improve women's ability to access them. As commenters on my birth control post noted, the prescription-only nature of birth control pills is another barrier to contraception that will still exist. (There are valid reasons for requiring prescriptions, but the tradeoff is that some women who want birth control pills will find it difficult to get them without interruption.)

Women who get health insurance through some religious employers may also continue to face the barrier of cost for contraception, because the HHS rule includes the following exemption:

Group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services. A religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii).

I hope the employers eligible for this exemption will remember that contraception is a key component of maternal and child health. Birth spacing is important for the prevention of low birth weight, premature birth, and other complications.

I'm happy about what the HHS rule means for women's health, but it's worth remembering that these services aren't actually free. Reducing cost barriers to contraception can save insurers money; as I noted in the previous post, one estimate of Medicaid costs is $257 per client on contraception vs. $12,613 per birth. The other services may or may not reduce future costs for the insurers that cover them, though.

This HHS requirement will affect premium prices, cost sharing, and benefits for other plan members. In this case, we may get very broad public-health benefits for very small increases in overall insurance costs. We're going to keep hearing calls for more and more services to be on the list of what health plans have to cover, though, and we should remember that these benefits all have costs attached.