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Pregnancy

Contraception Should Be Covered As Preventive Care, Opinion Piece States (Medical News Today)

A "little-noticed" provision in the federal health reform law (PL 111-148) "could greatly expand access to
contraception by requiring insurance companies to cover it without any out-of-pocket costs," which could
"result in fewer unintended pregnancies and abortions," Guttmacher Institute Senior Public Policy
Associate Adam Sonfield writes in a CNN opinion piece. The amendment, authored by Sen. Barbara
Mikulski (D-Md.), requires insurers, starting this fall, to cover women's preventive care and screenings
without additional cost-sharing, such as copayments or deductibles.

The amendment's supporters "made clear" that they intended contraception to be included, although the
final decision is left to HHS under the evidence-based guidelines it is tasked with creating, Sonfield
writes. The decision to include contraception in the guidelines "should, in truth, be an easy one," as the
"overwhelmingly positive preventive health effect" of contraception "is well-documented," he continues,
noting that women with planned pregnancies access prenatal care sooner than women with unintended
pregnancies. Women with planned pregnancies are also less likely to experience maternal or fetal illness
or have a low-birthweight infant, Sonfield adds.

The "potential" for coverage of contraception "will become reality only if the new health care law is
implemented in a way that takes its cues on contraception from successful precedents in the public and
private sectors," Sonfield continues, adding, "It must also heed the overwhelming evidence on the
medical, social and economic benefit of contraception."

According to Sonfield, contraception coverage "would extend ... significant benefits to more women and
their families by closing gaps in insurance coverage" and "reduc[ing] the disincentive to seeking care that
even modest cost-sharing can pose." He notes that average copayments in employer-sponsored insurance
have "increased considerably" in the past 10 years, from $29 in 2000 to as much as $46 in 2009 for many
brand-name drugs, including some oral contraceptives.

In addition, there are "ample precedents from both the public and private sectors for including
contraceptive services in basic preventive care," Sonfield writes, citing Medicaid and other federal and
state health programs.. He notes that several medical organizations -- such as the American College of
Obstetricians and Gynecologists, the American Public Health Association and the March of Dimes -- have
"long endorsed contraception in order to promote the health of women and newborns."

Preventing unintended pregnancy has substantial social and economic benefits, such as "allowing women
to complete their education and participate fully in the labor force," Sonfield continues. According to a
Guttmacher study, every $1 invested in public family planning services saves $3.74 in pregnancy-related
Medicaid expenditures, he adds. Furthermore, comprehensive family planning coverage under private-
sector insurance plans "would at most cost just a fraction of a percent of overall premiums -- even without
factoring in any cost-savings," Sonfield writes, noting that an analysis by the National Business Group on
Health estimates it costs employers 15% to 17% more when contraception coverage is not included in
employee health plans.
"One additional benefit that should appeal to Americans from across the political spectrum is [that]
helping women avoid unintended pregnancy has the potential to significantly reduce the need for
abortion," according to Sonfield. He adds that the two-thirds of sexually active women in the U.S. who
consistently and correctly use contraception account for 5% of all unintended pregnancies and abortions.
"Removing cost as one of the barriers to effective contraceptive use is not only a common sense policy, it
truly marks the elusive common ground on abortion that many Americans are looking for," Sonfield
writes.

"In short, the case for ensuring family planning services are comprehensively integrated into women's
preventive care and insurance coverage is compelling," Sonfield says, concluding, "More and better
contraceptive use will lead to more pregnancies that are planned and wanted, which will lead to more
women who are healthy during their pregnancies and whose babies are born healthy" (Sonfield, CNN,
6/7).

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