January 31, 2012

Full Coverage of Contraception Costs for Insured Employees

The Obama administration recently announced that contraceptives must now be covered by employer-sponsored health insurance plans.

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The Obama administration will now require employer-sponsored insurance plans to provide full coverage of their employees’ contraception costs, Health and Human Services Secretary Kathleen Sebelius announced Friday, Jan. 20th. Additionally, the loophole currently exempting religious-based employers will not be broadened, much to the chagrin of religious groups that fear that implementation of the HHS regulations will involve a compromise of religious beliefs.

The HHS regulations will require company health plans to fully cover the cost of all FDA-approved contraceptives, including “morning after” pills such as Plan B (it remains to be seen whether the mandate will cover the controversial “abortion pill,” RU-486, which is FDA-approved, but not a contraceptive by definition). The Obama administration has granted faith-based intuitions a year-long extension before enforcing compliance with the mandate, in the hopes that institutions can use that time to make the institutional and policy adjustments needed to ensure a smooth, mutually-acceptable transition to implementation. Some religious institutions (such as houses of worship and religious charities) will be exempt from the plan, however non-exempt religious institutions will have to cover their employees’ birth control costs.

The center of the hubbub over the HHS regulations over the past year, however, has been the size of the loophole. The mandate currently defines a religious employer as a nonprofit that “has the inculcation of religious values as its purpose” and “primarily employs persons who share its religious tenets” and “primarily serves persons who share its religious tenets.” Opponents of the mandate have lobbied long and hard to amend the language of the HHS regulations to exclude institutions such as Catholic hospitals and universities, and greeted the recent announcement with great vehemence.

Timothy Dolan, president of the U.S. Conference of Catholic Bishops, backed by a great number of Catholic and Christian leaders from around the country, has expressed passionate opposition to the HHS regulations . Dolan stated on Friday that the Obama administration is both violating conscience and compromising religious freedom with the mandate. The United States Conference of Catholic Bishops plans to legally challenge the constitutionality of the mandate in the near future.

On the other hand, women’s rights lobbyists and pro-choice groups are celebrating after a long battle that the religious exemption will not be expanded. The mandate marks the end of a more-than-decade long controversy, initially brought to the public eye by insurers’ inclusion of Viagra and exclusion of birth control in company health plans.

The mandate is based upon recommendations for women’s preventive health care issued by the Institute of Medicine. It is also in compliance with the U.S. Equal Employment Opportunity Commission’s 2000 announcement that an employer’s failure to provide coverage of contraception, when it covers other prescription drugs and preventive care, is a violation of protections against sex discrimination under Title VII of the Civil Rights Act.

The Physicians for Reproductive Choice and Health (PRCH) summarizes the public health argument for the mandate firmly and succinctly, saying:

“About half of all pregnancies in the United States are unintended. Regular use of contraception prevents unintended pregnancy and reduces the need for abortion. Contraception also allows women to determine the timing and spacing of pregnancies, protecting their health and improving the well-being of their children. Contraceptive use saves money by avoiding the costs of unintended pregnancy and by making pregnancies healthier, saving millions in health care expenses. Several contraceptives also have non-contraceptive health benefits, such as decreasing the risk of certain cancers and treating debilitating menstrual problems. Making contraception more affordable is a significant step forward for the health of women and their families.” (Please see full article for citations).

Regardless of religious affiliation, the mandate provides broader access for those who choose to use contraceptives. Removing cost-related barriers is an important and necessary step towards granting more Americans access to basic and essential health services. But what will the affect of the new mandate be on rates of unintended pregnancy? Perhaps it might even be found to have no effect, and that the primary group affected by cost-related barriers to birth control access is not composed of those employed individuals with health insurance who are now benefited by the HHS regulations. Regardless, maybe the benefits granted by the mandate will one day be seen to outweigh the costs to faith-based institutions.

For more information, and to see if you are affected, please refer to the Guttmacher Institute’s Insurance Coverage of Contraceptives brief.