Health and women's advocates are praising the Institute of Medicine (IOM)'s recent recommendations to include prescription birth control among the preventive health services that insurance companies must cover without a co-pay under the Affordable Care Act. This is important because cost can be a significant barrier to the consistent, effective use of birth control. For decades, birth control has been excluded from many health plans, but even when it is covered, cost-sharing keeps some women from getting it or using it consistently. A 2010 survey reveals that more than a third of women voters struggle with the cost of birth control, and the IOM report notes that women are consistently more likely than men to delay or forego health care because of cost.
The consequences of cost-related barriers to birth control are signficant: According to the Guttmacher Institute, women who do not use contraceptives or use them inconsistently account for 95% of the three million unintended pregnancies that occur every year. Unintended pregnancies can have harmful physical and emotional health effects for women, especially those who sufffer from chronic medical conditions or are at risk for health complications resulting from pregnancy. The IOM's recommendation to provide birth control as part of preventive health services is an important step toward improving the health and well-being for insured women.
As we celebrate this achievement, however, we must remember that for many women the fight for reproductive and sexual health care continues. Even with private insurance expansion under the Affordable Care Act, many women will be uninsured or covered by Medicaid. Currently, the uninsured and many Medicaid beneficiaries rely on clinics that provide free or low-cost reproductive health care, including birth control, and these clinics depend heavily on federal and state funding. Cuts in funding for family planning services, and the more radical defunding attacks that target providers of free and low-cost birth control are threatening reproductive health access and the well-being of our most vulnerable women.
Planned Parenthood has been the most visible target of these attacks on women's preventive health services. After Republicans in the U.S. House of Representatives led an unsuccessful attempt to defund Planned Parenthood, states took up the fight. Indiana was the first to enact a law prohibiting Planned Parenthood from receiving Medicaid payments or federal funding for disease intervention services. The good news is that, so far, the U.S. Department of Health and Human Services (HHS) and a federal court are preventing implementation of the Indiana law on the grounds that it violates federal law and would jeopardize critical health care access for women. The bad news is that neither this court decision, nor HHS's threat that such action would jeopardize Indiana's Medicaid funding, has deterred other states from similar attacks. In New Hampshire, for example, the State's Executive Council essentially ignored its own legislature when it voted to cancel the state's contract with Planned Parenthood. Other defunding attempts are underway in Kansas, North Carolina, Texas and Oklahoma.
This war on Planned Parenthood is purportedly driven by anti-abortion sentiment, but abortion is only a small portion of the services it provides (less than 3% in one case). Moreover, it is already prohibited from using government funding for abortion-related services. The overwhelming amount of services provided by Planned Parenthood involves free or low cost birth control, screening and treatment for sexually transmitted diseases, breast and cervical cancer testing, prenatal care, and contraceptive counseling - precisely the preventive health services that the IOM report just found to be critical to women's health.
In fact, family planning services in general are vulnerable to federal and state cuts in funding. For example, in February the House voted to eliminate Title X funding which helps to pay for the preventive reproductive health services recommended by the IOM; according to the Guttmacher Institute, about 4.7 million Americans get health care from clinics funded by Title X money. And in New Jersey, the Governor reportedly cut $7.5 million for clinics specializing in women's reproductive health, "effectively eliminating any public funding for family planning services."
In addition to urging HHS to adopt the IOM recommendations with respect to insurance coverage, we must make sure that this report has implications beyond private insurance reform. We must use it to prevent federal and state lawmakers from making public funding decisions that threaten access to birth control and other preventive health services for the uninsured and Medicaid beneficiaries.
