published Sunday, August 7th, 2011

Expanded care for women

One of the most persistent political battles in Washington revolves around women's health care rights. Health-care advocates and allied Democrats work to extend to women the benefits of family-planning services and access to reproductive health care and contraceptives. Right-wing Republicans usually try to block such aid.

Republicans generally base their opposition to these essential services on the fallacious notion that such aid might promote abortions. Yet most studies show that such aid actually reduces abortions -- and also significantly improves the health and well-being of women generally. It is this fact-based science that undergirds the Obama administration's new reproductive health care standards, issued last Monday, to require health insurers to cover all federally approved contraceptives for women without charge.

The new health-care standard, among a range of other preventive services for women, is to take effect on or after Aug. 1 next year as part of the Affordable Care Act, the short title of the health care reform act that is to be fully phased in by 2014.

The new standards for preventive and reproductive health services for women follow recommendations from the National Academy of Sciences and are based on widely documented findings in a large number of studies.

The larger range of new preventive standards require insurers to provide women -- without deductibles, copays or other charges -- mammograms, colonoscopies, blood pressure checks, immunizations for children, screening for gestational diabetes in pregnant women; screening for HIV and human papilloma virus and cervical cancer; prenatal and preconception care; screening for domestic violence; counseling and equipment, including breast pumps, to promote breast-feeding; and annual preventive care.

In addition to generic contraceptives, the required reproductive services include sterilization procedures, as well as emergency contraceptives, including Plan B pills and a pill known as ella. Under the new standards, insurers may use "reasonable medical management techniques" to control costs. That would allow them to charge for brand-name contraceptives if covered generic pills are equally efficacious.

Such coverage should be routine. Certainly it should not be controversial. That goes for reproductive care and contraceptives, as well. Studies by the National Academy of Sciences, for example, have found that free contraceptives are especially important because nearly half of all pregnancies in the United States are unintended, and about 40 percent of these pregnancies end in abortion.

Thus it seems clear that provision of family planning, contraceptives and reproductive care would substantially improve women's health, while at the same time drastically reducing abortions and the social costs that often result from unplanned births.

Still, Republican opposition to the new standards seem inevitable. Earlier this year, for instance, Republican-controlled state governments, in Indiana and half-a-dozen other states (including Wisconsin, Texas, Tennessee and North Carolina), adopted or began promoting laws banning the use of Medicaid funds to provide women essential reproductive health services at Planned Parenthood clinics. The did so on the charge that Medicaid funds might be used for abortions, though Medicaid law strictly forbids that. The result is that their unreasonableness and myopic focus on abortion stands as a barrier to other health care that many women need.

At least six states -- Kansas, Oklahoma, Nebraska, Idaho, Indiana and Virginia -- also banned coverage of abortion in the health insurance exchanges that are being created to implement the Affordable Care Act. That is fundamentally unfair and egregiously punitive to women. Purchase of these private plans will be made by individual women and families. State governments are wrong to violate their inherent right to the broad coverage that women want to purchase.

Such punitive measures wrongly taint the value and need for broader availability of reproductive and preventive health care for women, and violate respect for women's rights. Conversely, the new coverage requirements for private insurers would serve a broad range of medical rights for women. It should also make them more effective advocates for the full range of reproductive rights that they deserve.

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