The Department of Health and Human Services (HHS) has announced new guidelines requiring health insurance plans to cover several women’s preventive services on or after August 1, 2012.  Among the inclusions are contraception and voluntary sterilization.  According to HHS Secretary Kathleen Sebelius the decision is a result of the Affordable Care Act’s (ACA) efforts to prevent problems before they start.  “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” she said.  The Institute of Medicine (IOM) conducted a scientific review of women’s health needs and gave recommendations on specific preventive measures; HHS has now approved those recommendations.

“Today, as part of the Affordable Care Act, we are announcing historic new guidelines that will help women get the care they need to stay healthy,” Sebelius said. “Today we are accepting the recommendations of the Institute of Medicine, so no woman in America needs to choose between paying a grocery bill and paying for the key care that can save her life.”

The new rules are one of the broadest and potentially popular provisions of the ACA. “Since birth control is the most common drug prescribed to women ages 18 to 44, insurance plans should cover it,” Sebelius said. “Not doing it would be like not covering flu shots.”  The new rules also apply to annual “well-woman” checkups; screening pregnant women for diabetes; DNA testing every three years for human papillomavirus (HPV) — which can cause certain cancers in women 30 years and older; annual screening and counseling for HIV; counseling to determine whether a woman is at risk for other sexually transmitted diseases; breast-feeding support, counseling and supplies including breast pumps; yearly screening and counseling for domestic violence; and sterilization methods.

Howard Koh, MD, HHS assistant secretary for health, estimated that by 2013, 34 million women between the ages of 18 and 64 will receive the benefits detailed in the new ruling.  Although preventive care saves money by avoiding or delaying more costly chronic disease care, Koh said the new benefits will involve a “small” increase in premium costs.

Stephanie Cutter, a deputy senior advisor to President Obama, said that, “As a result of the Affordable Care Act, the new health reform law, insurance companies have to provide preventative care with no out-of-pocket costs.  There were never any guidelines for women’s health to make sure they stay healthy throughout the course of their lives.  Today, that’s no longer the case.  We have a set of recommended preventative services for women.  Private insurance companies,” Cutter said, “have to provide the services with no out-of-pocket costs.  Many of the benefits we’re announcing today are already part of large private healthcare care, employer plans, and they’re part of federal health care benefits.  Members of Congress have the benefits. Now, they’re going to be available to all women.”

“For women’s health, this is historic — a really important turning point,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center.  At present, women pay as much as $50 a month for birth control pills, even if they have insurance coverage, said Dr. Allison Cowett, director of the Center for Reproductive Health at the University of Illinois at Chicago Medical Center.  For many women, this is a financial hardship and a disincentive to practice consistent birth control.  Fully 95 percent of women who have unplanned pregnancies report using contraception only occasionally or never — often because it’s too expensive, according to the Guttmacher Institute, a nonpartisan research organization.  Birth control has been shown to improve maternal and child health, in addition to reducing unwanted pregnancies and abortions.

The guidelines, which would compel insurance companies to cover costs and eliminate co-pays and deductibles, have their critics. Birth control has been controversial since Margaret Sanger opened the United States’ first family planning clinic in 1916 — and ended up in prison for it. While many believe that contraception is the best method to prevent unwanted pregnancies, others support abstinence education. The United States Conference of Catholic Bishops opposes the new guidelines, saying, “Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible.”  Women’s rights advocates argue that the benefits of free birth control have uses other than preventing pregnancy. “The number of children we have determines how many we need to educate, how many we need to employ,” says Roosevelt Institute Senior Fellow Ellen Chesler.  “The social and economical outcomes of contraception are critical.”

The new guidelines will not apply to religious institutions that offer health insurance to employees.  Not surprisingly, health insurers also oppose the rules.  The Institute of Medicine counters that the “direct medical cost of unintended pregnancy in 2003 was $5 billion, with a savings from contraception that year estimated at $19.3 billion.  With nearly half of pregnancies unintended, there’s quite a bit of room to save money with free contraception.”  One estimate of the cost of birth control for women is between $3,600 and $18,000 over a lifetime, depending on insurance, the form of contraception and other factors.