Why the IOM Got It Right

For too long, adequate health insurance coverage has been out of reach for many women, and their health—and often the health of their families—has suffered. That’s why the recommendations made Tuesday by the medical and scientific experts convened by the Institute of Medicine are such a major step forward for women. Once in effect, they will help address some of the long-standing discriminatory practices and barriers women have faced in the health care system.

The experts determined that the full range of FDA-approved contraception, yearly well-woman visits, support for breast feeding, counseling for sexually transmitted infections, and screening and counseling for domestic violence, among others, are essential women’s preventive health services and should be covered by health insurers with no co-pays.

The Affordable Care Act requires all new health insurance plans to cover a list of preventive health services, as identified by the Department of Health & Human Services (HHS), and provide them with no out-of-pocket expenses for women. Based on the expert recommendations, HHS will determine which of these screenings and services for women will be included.

These new guidelines are historic and will go a long way to protecting and promoting women’s health. But opponents of contraception have sounded the alarm and will no doubt make political demands to undermine this protection. However, the Institute of Medicine merely acknowledged what most of us already know: contraception is basic, essential health care. Overwhelming majorities of women use contraception to protect our health and prevent unintended pregnancy, and nearly all will use contraception at some point in our lives.

Research from the non-partisan Guttmacher Institute bears this out: nearly all women aged 15-44 who have had sexual intercourse have used at least one form of contraception. Among the 43 million fertile, sexually active women who don’t currently want to become pregnant, 89% are using contraception. It is a normal, mainstream fact of life.

There is nothing new or novel about requiring health insurers to cover contraception. For over ten years civil rights laws have made explicit that employers who provide health insurance plans that cover other preventive health care and prescription drugs must cover contraception.  Twenty eight states require contraceptive coverage in private plans.  And the Medicaid program has long required contraceptives to be included as part of the coverage that Medicaid beneficiaries are afforded.

In addition to recognizing the fact that contraceptive coverage is already standard practice in both public and private health insurance plans, the non-partisan, independent panel of experts made its determination based on a review of the medical and scientific evidence regarding unintended pregnancy; similar recommendations of numerous health care professional associations and other organizations, including the federal government itself; the effectiveness of contraceptives; and the fact that contraceptive coverage is already standard practice in both public and private insurance plans. The research also shows that costs—including co-payments and other cost-sharing requirements—play a key role in the contraceptive behavior of substantial numbers of U.S. women, often leading them to use less effective methods or to pay for contraception at the expense of other essential needs.

Given the strong case made by the IOM, we are confident that Health and Human Services Secretary Kathleen Sebelius will follow the evidence-based recommendations of this expert panel and stand with the millions of women who depend on quality, affordable, comprehensive health insurance.