Health Care Reform and Women: Birth Control 0, Sex Discrimination 1

By Erin Matson, NOW Action Vice President

Today the Obama administration announced new guidelines under the Affordable Care Act for preventive care, which will require insurers to cover a wide range of preventive services without charging co-pays or deductibles. Sounds good and makes sense, but a review of the list of what’s covered reveals a conspicuous omission: contraceptive coverage.

At any given time, 70 percent of women between the ages of 15 and 44 are sexually active and do not want to become pregnant. Of that group, 98 percent, or virtually all, have used a form of contraceptive. This widespread need and use of contraceptives indicates that they comprise one of the most popular types of preventive care for women in this country.

Curiously, the omission of contraceptive coverage also flies in the face of the government’s own data on the return on investment shown within the longstanding Medicaid program. Of women who use Medicaid, every dollar that has been spent helping them avoid unwanted pregnancies has saved $3.74 on medical expenses that would have been needed. (Many thanks to the Guttmacher Institute for these statistics.)

I have lived in Washington long enough to know that writing this post may be just enough for a Democratic Party enthusiast to call me up and tell me why, with all sorts of unconvincing words, contraceptives have not been classified as preventive care.

Or perhaps I would hear something about the undue power and influence of those 14 paid lobbyists roaming Capitol Hill on behalf of the U.S. Conference of Catholic Bishops, which argues that contraceptives provide abortion care and should therefore be accessible to nobody, which is wholly scientifically inaccurate, medically impossible and in violation of the Constitution as read by the Supreme Court (for now, at least).

Even more likely would be an entreaty to focus on the good these new guidelines have created for women’s reproductive health: covering cervical cancer screenings for sexually active women, anemia screenings for pregnant women and mammograms for women over 40 every one to two years. To those ends and more, very good. But.

Most of the women in any elevator are sexually active, often with men, and trying not to become pregnant. If you ask them if contraceptives are preventive care, they will give you a resounding yes.

Somewhat paradoxically, the preventive care guidelines do require insurers to provide free folic acid supplements to women who “may become pregnant.” Words matter — this is preventive care for women who “may become,” not necessarily “are trying to become” pregnant. It is an acknowledgement that an ability to become pregnant also comes with potential consequences for health, in other words, that a potential to become pregnant justifies preventive care. That’s what contraceptive coverage is.

Outrageous? Yes. While we can be happy that insurers will cover a long list of good preventive care services that people need, conspicuously omitting what may be the most widely needed and used form of preventive care for young women is discrimination on the basis of sex. It’s wrong, and it needs to be fixed.

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