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Free Birth Control, Reproductive Services for Women Starting August 1


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free birth control preventive services august 1 aca

Approved oral contraceptives and other reproductive services for women will be free with private health insurance policies starting August 1; image courtesy of iStockphoto/RyanJLane

Since last August, I’ve been counting down the days until my 30th birthday this Wednesday. You see, I’ve got money coming my way—not just in the form of birthday checks from my grandmother and aunts—but an even larger chunk of change, spread out over the entire year. Starting August 1, I, along with millions of women in the U.S., are going to start saving hundreds of dollars annually now that a new Affordable Care Act (ACA) provision will begin removing insurance co-pays for reproductive preventive services for women. For the year to come, I’m expecting to keep  at least $395 a year in “cost-sharing” co-pays that I will no longer be paying.

“While women are more likely to need preventive health care services, they often have less ability to pay,” an official at the U.S. Department of Health and Human Services (HHS) explained to me in a recent email. “Removing cost sharing requirements lets women decide which preventive services they’ll use and when.”

Starting this Wednesday, the ACA requires private insurance companies to offer free:

  • approved contraceptives (per the U.S. Food and Drug Administration’s recommended list, which includes major oral contraceptives as well as sterilization procedures) as well as contraceptive counseling;
  • well-woman visits (those annual trips in to the OB/GYN to get everything checked out);
  • breastfeeding supplies (such as breast pumps), support and counseling;
  • STI (sexually transmitted infection) counseling—including HIV testing and counseling as well as genetic HPV (human papillomaviurs) testing for women 30 and older;
  • screening for gestational diabetes (a condition which can increase the risk for complications and developing type 2 diabetes later as well as metabolic challenges for the child); and
  • domestic violence screening and counseling.

“These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” Kathleen Sebelius, U.S. Department of Health and Human Services secretary, said in a prepared statement last August announcing the new provisions. The HHS selected these guidelines upon recommendations made in a July 2011 report from the Institute of Medicine.

The aim of the new changes is to close some of the screening and preventive measures that were not covered for women under previous changes that went into effect in September 2010 (which included free blood pressure and cholesterol screening for both men and women). Earlier provisions in the ACA have already mandated other free preventive services for women, including mammograms and cervical cancer screening.

I count myself among the fortunate majority (about 64 percent of the U.S. population) who has private health insurance. I have only had to pay out of pocket for co-pays for birth control and well-woman visits. The new requirements will not make these additional services free to women who are not on private insurance, but depending on income, many women might already have access to free preventive health services through other means.

The small co-pays once a month at the pharmacy and once a year at the doctor’s office might not seem like much—$30 here and $35 there—but a 2009 report from the Commonwealth Fund found that more than half of women reported either skipping or putting off preventive care because of cost. “The inability of patients to access preventive care contributes to the nation’s escalating health care costs, hurts people’s health and lowers productivity,” the HHS official notes.

Not to mention that with the recent U.S. Centers for Disease Control and Prevention finding that one third of births in the U.S. are still a result of unplanned pregnancies, fewer barriers to family planning—and to preventive healthcare once women decide they want to get pregnant—should be a boost for everyone.

The new provision allows insurance companies to manage costs by, for example, continuing to charge co-pays for name-brand birth control pills if the generics are offered to their policyholders at no cost. And many plans will not be required to incorporate the changes until the new “policy year” starts, on January 1, 2013—although some are choosing to start them right away.

It’s hard to say exactly where the extra money for getting rid of these co-pays will come from. “Any time benefits are added to a policy, the additional costs are reflected in the cost of health care coverage,” Robert Zirkelbach, a spokes person for America’s Health Insurance Plans, a trade group that represents insurance companies, wrote to me in an email. But he declined to speculate about how any particular companies factor in the costs of this new coverage to the bottom line. Fewer unplanned pregnancies, less severe complications due to gestational diabetes and more kids and moms who are healthier as a result of breastfeeding, however, should reduce reimbursements for insurance companies for many decades to come.

Health insurance companies already “encourage policyholders to get recommended preventive care,” Zirkelbach says. For good reason—it saves them a lot of money.

But despite previous “encouragement,” removing financial hurdles—even seemingly small ones—should increase the use of these services even further. As the HHS official noted, “Reducing cost sharing increases use of preventive services.”

So for my birthday, I’ll appreciate the extra money in my pocket for the coming year, but I’ll be even happier to know that these newly accessible services should make planning and raising healthy families easier for both women and men.

Katherine Harmon Courage About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. danarel 11:48 pm 07/31/2012

    this is good for woman and good for our country.

    Link to this
  2. 2. lilolme 1:04 am 08/1/2012

    Don’t worry, you’ll be paying for it somewhere. Nothing is free.

    Link to this
  3. 3. danarel 2:19 am 08/1/2012

    im happy to know my tax dollars go to something like this. preventative care is so important and paying for birth control is a lot cheaper than paying for a full pregnancy and much cheaper than bringing in unwanted children into the world who could end up in our flawed and sadly over crowded foster care system.

    this is a great step for towards a true socialized healthcare system that this country needs.

    Link to this
  4. 4. drafter 11:30 am 08/1/2012

    Ignoring the fact that nothing is free and if it’s free to you then someone else is paying for it. Why should someone else pay for anything another person needs. We all need food why don’t we require the local grocery store to give us all food for free. This is an appropriate analogy since it is not tax dollars paying for this health care, as someone earlier suggested it is a law requiring private insurance to provided these services, essentially it is a tax concealed as a requirement to get around raising taxes to support this.

    Link to this
  5. 5. Durazac 11:53 am 08/1/2012

    So, help me understand this. As a businessman I am now responsible for paying for my female employees sexual behavior and all the effects thereof….
    Yet, I cannot mention the word sex around said employees, and in fact, probably cannot even suggest that I disapprove of paying for her sexuality without risk of a lawsuit from said employee.

    I worry about women’s health, just like I worry about other men’s health – not at all. It is your responsibility and none other. If you give up paying, you should give up control.

    The solution to me is simple, don’t hire any women more than part time. In fact, since I’ll be paying a fine, I mean tax, for all the employees I don’t insure I may as well hire ONLY part time. And lucky for me, with all the people out on the street, employees are cheap, so I can be picky. I would worry about competition for these workers, but since the small businesses are under the feds thumb, there won’t be much more competition for the foreseeable future. It’s too darn expensive.

    Heck, why even run a business at all? The joy is gone from it, the demands of government are crushing any hope of a future, and I would and did do far better as a mega corp employee wearing a suit and solving other people’s problems.

    Link to this
  6. 6. Garen 12:53 pm 08/1/2012

    Durazac, if that is how little your business means to you, then by all means, go ahead and get a corporation job. If you have employees, you have a responsibility to make sure they’re taken of for as long as they work for you.

    Humans are social creatures, and we live in a world where you pretty much have to rely on the social structure at some point or another, whether it be for roads, public transit, healthcare, water and utilities, or what have you. We live in a society where we don’t believe that unfortunate people should be left to starve, and so we put our tax dollars toward things like food stamps. It’s part of being a member of society, and remember, just because you or someone close to you doesn’t need it now, doesn’t mean you never will.

    Link to this
  7. 7. JWWright 3:31 pm 08/1/2012

    Isnt it funny how the left uses the smoke & mirrors of “Free” to redistribute the money of others?

    The left blindly buy into this charade, and easily disregard the reality: It is not free. Ins. Co’s increase costs for paying customers; redistribution.

    The left also disregards the dozens of new, massive tax hikes on the Middle Class (unrelated to the Mandate)which makes it clear that Obama lied about not raising taxes on the Middle Class.

    Leftism must be advanced via mis-direction and, well, naked lies.

    Its the only way they can support the belief that ones “rights” can violate the rights of others, namely their right to property.

    Your right cannot cost anyone else their money, time ar any resource.

    But leftist “rights” always seem to, oddly enough.

    Link to this
  8. 8. scepticalofsciam 3:39 pm 08/1/2012

    It’s not free and that is an unfortunate mentality nowadays as nothing is free. The insurance companies pay nothing. The insureds will pay in the form of higher premiums. Let’s follow this line of reasoning to the logical conclusion. Everything is free and nobody pays. Now, exactly what kind of life will we have? It’s called socialism, the great failed experiment of the 20th century, where everybody had little except for the politically connected. Think about that next time you hear the government provide something for ‘free’. Ironically, it’s the young people who will pay back the money borrowed today for all the ‘free’ stuff. Good luck!

    Link to this
  9. 9. shorewood 6:20 pm 08/1/2012

    This article is tongue-in-cheek, right?

    I wish journalism schools would require a basic course in economics. There would be a lot less writing like this article.

    Does the author really believe this stuff?

    Link to this
  10. 10. Squeedle 7:23 pm 08/1/2012

    While I in general agree with Ms. Harmon’s opinion, I don’t read Scientific American to get political opinions; I read it for the science reporting. If Ms. Harmon wished to write about how public health is affected by completely subsidized birth control, for example, increased prevention of unwanted pregnancies resulted in a drop in US infant mortality, or a reduction in population growth, or how increased condom use resulted, causing lower transmission rate of STDs, that would be different. A real world example: as a result of this policy it is in my view, very likely that HPV infection rates will go down, since more women will be getting vaccinated. I’m not picking on Ms Harmon; I see a lot of opining in the SciAm blogs that is nearly devoid of science content and I’m tired of it.

    Link to this
  11. 11. danarel 1:54 am 08/2/2012

    im shocked by the amount of self centered selfish people commenting on this post.

    congratulations, you are whats wrong with the country. now go be grumpy somewhere else.

    Link to this
  12. 12. Na g n o s t ic 2:23 am 08/2/2012

    I’m pleased to see that many here recognize there’s no such thing as “free” services. The author alludes to this fact towards the end of her piece.

    Those who support the notion that it’s reasonable to make men and sexually non-active people of both sexes give money to sexually active females logically infer that sexually active females have no control over their impulses, and are little more that passive sperm receptacles.

    Link to this
  13. 13. BigPicture24 9:31 am 08/2/2012

    It’s interesting how some of these comments solely hold women responsible for sexual behavior resulting in pregnancy. Don’t they realize that this news is just as good for men as well? Obviously it takes both genders to have children. In the grand scheme of things wouldn’t it be less expensive to have your male employees not have unplanned dependents on their health insurance? Your male employees are having sex too, maybe even with your female employees. At a minimum, wouldn’t it be nice to know that the women your male employees are having sex with are less likely to have children/reproductive problems because the ACA is making contraception more accessible?

    It baffles me how critics of this aspect of the ACA so narrowly construe the realities of human sexual behavior. In the long run, the benefits of free birth control and increased reproductive services will far outweigh the initial costs.

    Link to this
  14. 14. g_rahman 12:07 pm 08/3/2012

    There are 3-ish reasons to take birth control:

    1. The obvious reason: to eliminate fertility.

    2. To prevent certain types of cancer.

    3. To regulate or treat certain medical conditions (acne, PMS, etc.; See http://www.webmd.com/sex/birth-control/features/other-reasons-to-take-the-pill )

    Let’s examine the argument that government should legislate complete coverage in each scenario.

    (1) When we use birth control as birth control, we are making a lifestyle choice. We are saying, “I want to have sex without the pregnancy that naturally follows.” There are other ways of avoiding pregnancy; for instance, not having sex. So, if someone _chooses_ to have sterile sex, it seems to me, their choice is _not_
    primarily a health concern and is instead a private lifestyle choice.

    In a similar vein, I may choose to engage in a risky behavior such as skydiving. If government can mandate
    coverage of birth control for the sake of avoiding the *risk* of pregnancy, shouldn’t I be able to make an
    argument that my lifestyle choice puts me at risk of injury or death, and therefore, the government should
    require coverage of preventative devices such as duly tested parachutes at no cost to me?

    The truth is, if you don’t want to get pregnant, you don’t _have_ to have sex. If you choose to, it’s your
    choice. Don’t ask to have it for free.

    2. Should birth control be covered because it can help prevent certain types of cancer? Should dark chocolate
    be covered because it prevents heart attacks? (
    http://www.webmd.com/diet/news/20120424/pick-dark-chocolate-health-benefits ) Should red wine be covered
    because it is good for the heart? ( http://www.mayoclinic.com/health/red-wine/HB00089/ ) Should all vitamins and supplements be covered? This may be a good reason to take it, but it isn’t a good reason to mandate coverage.

    I would note that birth control may help prevent some types of cancer, but it also increases your risk of breast cancer. ( http://www.wellnesstimes.com/articles/real-risks-birth-control-pills )

    3. To regulate or treat certain medical conditions: this argument has the most power behind it; however, let’s look at what we do in other such cases: a co-pay. Why should birth control get special treatment? Also, why doesn’t the mandate limit coverage by adding language: “for use in the treatment of medical conditions only”?

    The arguments for complete coverage, when broken down this way, seem to be unsustainable. Standard coverage could be argued for #3. Indeed, I would not be opposed to such a use, provided there is a real, documented health concern that is treatable (in the best way) by birth control.

    Link to this
  15. 15. g_rahman 12:33 pm 08/3/2012

    My first post seems to have been removed, maybe because I attempted to provide references via links. I’ll remove the references. Hope it doesn’t weaken my points.

    There are 3-ish reasons to take birth control:

    1. The obvious reason: to eliminate fertility.

    2. To prevent certain types of cancer.

    3. To regulate or treat certain medical conditions (acne, PMS, etc.; See an article on WebMD titled “Other Reasons to Take the Pill”)

    Let’s examine the argument that government should legislate complete coverage in each scenario.

    (1) When we use birth control as birth control, we are making a lifestyle choice. We are saying, “I want to have sex without the pregnancy that naturally follows.” There are other ways of avoiding pregnancy; for instance, not having sex. So, if someone _chooses_ to have sterile sex, it seems to me, their choice is _not_ primarily a health concern and is instead a private lifestyle choice.

    In a similar vein, I may choose to engage in a risky behavior such as skydiving. If government can mandate coverage of birth control for the sake of avoiding the *risk* of pregnancy, shouldn’t I be able to make an argument that my lifestyle choice puts me at risk of injury or death, and therefore, the government should require coverage of preventative devices such as duly tested parachutes at no cost to me?

    The truth is, if you don’t want to get pregnant, you don’t _have_ to have sex. If you choose to, it’s your choice. Don’t make us pay for it.

    2. Should birth control be covered because it can help prevent certain types of cancer? Should dark chocolate be covered because it prevents heart attacks? Should red wine be covered because it is good for the heart? Should all vitamins and supplements be covered? This may be a good reason to take it, but it isn’t a good reason to mandate coverage.

    I would note that birth control may help prevent some types of cancer, but it also increases your risk of breast cancer.

    3. To regulate or treat certain medical conditions: this argument has the most power behind it; however, let’s look at what we do in other such cases: a co-pay. Why should birth control get special treatment? Also, why doesn’t the mandate limit coverage by adding language: “for use in the treatment of medical conditions only”?

    The arguments for complete coverage, when broken down this way, seem to be unsustainable. Standard coverage could be argued for #3. Indeed, I would not be opposed to such a use, provided there is a real, documented health concern that is treatable (in the best way) by birth control.

    Link to this
  16. 16. jerrys 6:03 pm 08/11/2012

    I also am a small businessman. As a result of the “Affordable” Care Act and things like “free” birth control, my health insurance costs are going up an estimated 30-40%. I won’t be able to afford it, and am going to have to drop the health insurance plan I have for all my employees. Part of the increase is the “free” birth control. No, my employees won’t be paying for it – I will be.

    I’m not being stingy. It’s either that or close shop and put all of my employees on the unemployment rolls.

    It really amazes me the lack of understanding how many liberals have about the world. But they want everyone else to pay for their birth control pills, health care, whatever.

    This type of article is exactly why I’ve not renewed my SA subscription. SA used to be a top science magazine. Under the current editorship, it has become more of an outlet for the political left. If I want politics, I’ll read the Washington Post.

    And now when I want Science, I read Science News and Discover. No more wasting my money on SA.

    Link to this
  17. 17. tremain2004 1:55 am 08/21/2012

    Pitiful
    Such excitement about a little bit of money that we will pay for. Better pay for your vitamins and makeup.
    No shame for some people.
    The previos commenter is correct.
    The PC leftest slide of SCIAM destroys credibility

    And I loved it for so lone

    Bob Tremain
    PhD

    Link to this

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