A Win for Women’s Health Access, a Win for the Network!

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The Women's Health Activist
November/December 2011

By Keely Monroe 

Women’s health advocates are celebrating an historic victory — the new requirement that insurance companies must cover contraception without any additional charges!  Because the Affordable Care Act (ACA) requires all new insurance plans to cover preventive health services without any co-pays, and because the Department of Health & Human Services (HHS) followed the medical experts’ recommendation that contraception be recognized as appropriate preventive health care for women, women will benefit from this new coverage requirement starting as soon as August 2012. The National Women’s Health Network and many other women’s health groups worked long and hard, over many years, for this important advance for women’s health and women’s health access. 
As proponents of reproductive justice, we know that contraception is a critical part of women’s health care. It is essential to women’s reproductive autonomy and the right to choose whether and when to have children. Ensuring that women can prevent unintended pregnancies and allow time between births also improves the health of mothers and babies and increases families’ financial security.
We also know that financial barriers can significantly reduce women’s access to reproductive health services. Studies show that even small co-pays can dramatically reduce the use of essential preventive care services; not surprisingly, this is especially true for people with lower incomes. For this reason, eliminating co-pays for contraception and other preventive care is a critical step toward  women’s reproductive autonomy and ensuring that women get the care they need. 
Since the early 1990s, advocates have pointed to the unequal financial burden that falls on women when insurance policies fail to cover contraception and women must pay out-of-pocket for these services. Since then, contraceptive coverage has improved in much of the United States: 28 states have enacted legislation requiring insurers to cover a full range of contraceptive options if they cover prescription drugs in general; and five states require all HMOs to provide coverage for contraception. Additionally, 14 states require employees to be notified if their health plan does not cover contraception.
Contraception IS Preventive Care
The NWHN’s commitment to ensuring that women have self-determination in their sexual and reproductive health guided both our long-term work on improving access to contraceptive services and our most recent, intense advocacy efforts on the Contraception is Prevention campaign that we conducted through Raising Women’s Voices for the Health Care We Need (RWV).  
From the start of health care reform deliberations in 2009, RWV identified improved contraceptive access as a key goal and worked hard to create opportunities for better contraceptive coverage under the ACA. We succeeded and, when the ACA was passed in 2010, it included a “Women’s Health Amendment” that created a specific women’s health directive, which built on the ACA’s requirements for  coverage of certain proven preventive care and screenings. The Amendment directed HHS to identify specific preventive health services for women that must be covered without any extra charges or co-pays, just as the law requires for other proven preventive care. Including this directive in the law was an important step toward our goal of improving contraceptive access. 
After the ACA was signed in 2010, we launched the Contraception is Prevention campaign to ensure that HHS would follow the path Congress created and deliver on this important promise to women. During the campaign, we made sure that women’s voices were heard by those making this critical policy decision. Through Contraception is Prevention we pressed for this victory on several fronts:
  • We filed formal comments with HHS requesting that the agency recognize contraception as preventive health care. Our comment letter was signed by 60 organizations representing diverse women, families, and communities.
  • NWHN’s Executive Director, Cindy Pearson, was invited to speak to the Institute of Medicine (IOM) Committee that developed recommendations for HHS on what preventive services should be covered. In her comments, Pearson outlined the evidence that contraception is necessary to ensure that women stay healthy, have healthy pregnancies, and bear healthy babies. She urged the Committee to act quickly to address this important unmet women’s health need. 
  • We conducted a national petition campaign that mobilized individuals and organizations all over the country to take action to support contraceptive coverage. RWV regional coordinators fanned out to community events nationwide, including women’s health forums, state and local health hearings, county fairs, farmer’s markets, and many other gatherings.
  • After the IOM Committee issued its recommendations, agreeing with ours, we once again ensured that women’s voices would be heard by hand-delivering the thousands of petition signatures we gathered to HHS, urging the Department to accept the IOM’s recommendations and require insurers to cover contraceptive care the same way it required them to cover other proven preventive health services (see photo).
These efforts yielded great results! On August 1, 2011, Kathleen Sebelius, Secretary of HHS announced that starting next summer, insurers will be required to cover key women’s preventive health care, including contraception, without co-pays. 
Secretary Sebelius’s decision to accept the IOM recommendations also will ensure that women have insurance coverage, at no extra cost, for a robust list of preventive health services, including breastfeeding counseling and supplies; screening for gestational diabetes; screening and counseling for intimate partner violence and sexually transmitted infections; and well-woman preventive care visits. This expanded coverage honors the essence of the ACA’s goal of giving people access to affordable and comprehensive health services.
The celebration was only marred by our disappointment that HHS announced its intent to offer religious employers the ability to refuse to provide contraceptive coverage to their employees.  RWV has filed comments asking HHS to eliminate the exemption so that all women, regardless of where they work, will benefit from this historic advance.
The Next Step…
Now that the policy is in place, women’s health advocates are focusing on making sure women know what to expect and how to take advantage of this benefit.  New insurance plans must comply with the new rules no later than August 1, 2012. For some women, that may mean the changes won’t take effect until the start of their plan’s coverage year, which is usually in January. But some insurance companies may decide to start sooner.
As August 2012 approaches, be on the lookout for our Countdown to Coverage campaign, which will help women figure out how to collect on this promise of health reform and get improved contraceptive coverage as soon as possible. For more about thedecision, see the Women’s Health Preventive Services Information Central page on the Raising Women’s Voices website, at www.raisingwomensvoices.net/wphc-info-central.