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No more co-pays for birth control, insurers told, as preventive health care coverage is expanded for women (Detroit Free Press)

Posted August 2, 2011 on The Detroit Free Press.

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By Ricardo Alonso-Zaldivar, Associated Press

Published: 08.02.11| Updated: 08.02.11

The Obama administration ushered in a historic change in women's health care on Monday: mandatory insurance coverage for birth control with no co-pays, starting as early as next August.

Health and Human Services Secretary Kathleen Sebelius said contraception is essential for women's good health. "Not doing it would be like not covering flu shots," she said.

For now, the federal requirements only affect new health plans, such as Michigan's high-risk pool for chronically uninsured people, or any new products that existing insurers may offer in the future.

Tens of millions of women are expected to gain coverage, a number likely to grow with time. At first, some plans may be exempt, but they could face pressure from members to include the new benefit.

Many employer-sponsored health plans already pay for contraception, even though they haven't been required to, said Helen Stojic, spokeswoman for Blue Cross Blue Shield of Michigan.

Still, the new rules are significant because "many Michigan women have struggled for years paying for birth control," said Sarah Scranton, executive director of Planned Parenthood Advocates of Michigan. "It's a historic victory for women here in Michigan and across the country."

The Associated Press contributed to this report.

Birth control is part of a package of women's preventive health services the government says must be covered by insurance

Thousands of Michigan women soon will be able to get free birth control and other essential preventive services as part of landmark health care reforms announced Monday by the federal government.

Many women have unintended pregnancies because they can't afford effective birth control, health officials say. Medicaid doesn't cover health care for single adults without children, said Dr. Richard Smith, an obstetrician/gynecologist at Detroit's Henry Ford Hospital and former president of the Michigan State Medical Society.

"It's a barrier to care," Smith said, that leads to higher infant mortality rates and other health problems.

The changes, announced Monday by the U.S. Department of Health and Human Services, will begin as early as August 2012, but mostly will be available by Jan. 1, 2013.

Early on, federal officials estimate, as many as 34 million American women between the ages of 18 and 64 will receive the extra services, through plans not exempted from the mandates.

The requirements apply to all forms of birth control approved by the federal Food and Drug Administration. That includes the pill, intrauterine devices, the morning-after pill and long-acting implantable contraceptives.

Services ranging from breast pumps for new mothers to counseling on domestic violence were also included in the broad expansion of women's preventive care under President Barack Obama's health care overhaul.

Current plans are exempt

The mandates, for now, exempt current products offered by many insurers. They apply to new companies and to new plans or products offered by existing insurers. Currently exempted plans could face pressure from their members to include the new coverage.

The administration gave insurers some leeway in determining what they will cover. For example, health plans will be able to charge co-pays for brand-name drugs in cases when an equally effective generic version is available. Federal officials said that while the services are free, costs of monthly premiums could rise slightly as insurers absorb the costs.

"Over a span of generations from grandmothers to granddaughters, we have come from birth control being a hope and a wish -- and almost luck -- to being recognized as a part of health care that improves women's health," said Cynthia Pearson of the National Women's Health Network, an advocacy group.

The rules include a provision that would allow religious institutions to opt out of offering birth control coverage. However, many conservatives support legislation by Rep. Jeff Fortenberry, R-Neb., that would codify a range of exceptions on religious and conscience grounds.

Plan B is included

Ed Rivet, legislative director for Right to Life of Michigan, said his organization awaits details about exemptions. He said the group particularly has concerns that the coverage mandates might be extended to products designed to chemically end pregnancies.

"We have concerns about contraception having an abortion-causing effect," he said.

Coverage with no co-pays for the morning-after pill is likely to become the most controversial part of the change. The FDA classifies Plan B and Ella as birth control, but some religious conservatives see the morning-after products as abortion drugs.

The HHS rules issued Monday do not require coverage of RU-486 and other drugs to chemically induce an abortion.

Some public health experts predicted the change will promote the use of costlier long-acting contraceptives, such as hormonal implants. More reliable than the pill, they are gaining popularity in some other economically advanced countries.

As recently as the 1990s, many health insurance plans didn't even cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans cover prescription contraceptives -- but with varying co-pays.

Marjorie Mitchell, executive director of the Michigan Universal Health Care Network, a proponent of reforms, said it's only fair that insurers offer contraception because "we've been paying for Viagra for awhile. It's a women's equity issue."

Free Press Medical Writer Patricia Anstett contributed to this report.

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