Federal officials drafting guidelines to implement health care reform should include contraception among the basic set of preventive services for women that private insurance plans must cover without cost sharing, concludes a new Guttmacher Institute analysis.

The so-called Mikulski amendment in the health care reform law enacted in March stipulates that preventive care and screenings for women are to be covered free of any cost sharing. However, while lawmakers who sponsored the amendment made clear their intent that contraceptive services be covered, the legislation leaves it up to the U.S. Department of Health and Human Services (DHHS) to develop new evidence-based guidelines that would define which services to include. It is not yet clear whether DHHS will draft the guidelines internally or commission an outside panel to do so.

"Advocates for women’s reproductive health fully expect that contraceptive services, counseling and supplies will be covered as preventive care, and this expectation is supported by ample precedent and strong evidence," says Adam Sonfield, author of the new analysis. "Not only has prevention of unintended pregnancy long been a key goal of U.S. public health policy, but medical providers, as well as a federal and state health programs, have long viewed contraception as a critical part of women’s preventive health care."

Sonfield identifies several key reasons why the new federal guidelines should classify family planning services as preventive care to be covered without cost sharing:

• Significant health benefits: The overwhelmingly positive impact of contraception as preventive care is well documented and includes a wide range of health benefits that result from having pregnancies that are planned and intended, including better prenatal care and decreased likelihood of fetal and maternal illness or low birth weight, compared with having unintended pregnancies. Coverage of contraceptive services, counseling and supplies without cost sharing would extend these significant benefits to more families by closing gaps in insurance coverage, reducing the disincentive to seeking care that even modest cost sharing can pose, and enhancing effectiveness of contraceptive use.
• Ample precedent: Public health programs, medical provider associations and private businesses all provide precedents for recognizing contraceptive services as effective preventive care. Official U.S. public health goals for the decade (in Healthy People 2010) specifically call for expanding access to family planning, and in particular expanding insurance coverage of contraception. A number of current federal and state health programs recognize family planning services as preventive care, as do the American College of Obstetricians and Gynecologists (among many other medical associations) and the maternal health organization March of Dimes.
• Costs and benefits: The social and economic benefits of preventing unintended pregnancy are significant, among them allowing women to complete their education and participate fully in the labor force. Contraceptive services are also highly cost effective, with every $1 invested in publicly funded family planning services saving $3.74 in pregnancy-related Medicaid expenditures. In the private sector, studies have found that offering insurance coverage of family planning in private insurance plans is inexpensive. One study estimates that it costs employers 15–17% more to exclude contraceptive coverage in employee health plans than to provide such coverage. The National Business Group on Health recommends that all employer-sponsored health plans include contraceptive services free of cost sharing as part of a minimum set of preventive care benefits.

"It simply makes eminent sense to ensure that family planning services are comprehensively integrated into preventive care," says Sonfield. "This must include coverage for the full range of contraceptive drugs and devices, related services such as insertion and removal of devices, and counseling and patient education."

Click here for "Contraception: An Integral Component of Preventive Care for Women," by Adam Sonfield, published in the Spring 2010 issue of the Guttmacher Policy Review.

Click here for a new Guttmacher Institute analysis on the impact of health care reform on sexual and reproductive health