Another Big Deal

Today, the Institute of Medicine (IOM) issued its recommendations to the Department of Health and Human Services (HHS) on which preventative-care services for women should be free under any health-insurance plan. Given that the Stupak-Pitts Amendment took abortion coverage out of the health-care equation, one would have thought that the guidelines would be uncontroversial. But the increasingly radical anti-abortion movement fought hard against the inclusion of contraception.

Today's IOM report basically repudiates their view:

Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy. Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems.

Now that IOM has weighed in, it's up to the administration to make a final decision. It may seem strange that such details are still being ironed out more than a year after the health-care law was passed. But the delay is part of an effective political strategy by Senator Barbara Mikulski and the Obama administration.

During health-care-reform deliberations in December 2009, the Senate approved the Women's Health Amendment (known as the Mikulski Amendment), which requires private health insurance plans to provide preventative services for women free of charge. But to avoid a political storm over contraception, the law wisely punted the decision of what would be covered off to HHS, which in turn asked for guidance from the IOM. What this has done is take the decision out of the political realm and left it up to medical experts. This not only makes it more likely that contraception will be covered but makes it harder for an anti-abortion, anti-contraception president to come along and strip it from the law.

That such a maneuver was necessary is a testament to how anti-abortion activists have succeeded in making something as popular as contraception a political lightning rod. Contraception is extremely popular, and polls show broad support for making it affordable. But that hasn't stopped them for successfully cutting off access. In a stroke of genius, the anti-choice movement has managed to repackage their resistance to contraception by folding it into their opposition to abortion. And what better way to do that than to name-drop Planned Parenthood?

Yesterday, the flagship anti-abortion publication, Life News, ran a story titled "Will Obama Admin Add Planned Parenthood Bailout to Obamacare?" -- an apparent reference to the fact that Planned Parenthood would be fully reimbursed by health insurers for providing contraception. But of course Planned Parenthood isn't receiving any more or less money. By eliminating out-of-pocket expenses for preventative services, the law simply shifts the cost burden from the patient to the insurance company. The government is not paying for these services, and they are not paying Planned Parenthood a dime. But everyone knows that Planned Parenthood is the anti-choice cause's deus ex machina, a bogeyman they haul out to turn any conversation about reproductive health into a conversation about abortion.

Beyond invoking Planned Parenthood, anti-choicers warn that including contraception among free services for women would "spell doom for rights of conscience." This argument hinges on the fact that those opposed to contraception would be forced to pay into insurance plans that cover contraception, therefore violating their "conscience rights" -- a right that the movement entirely made up. Insurance plans already cover contraception; they just force individuals to pick up a larger portion of the tab. The Life News story concludes with a rallying cry: "There is no issue in DC more important than this, neither the 'debt ceiling' nor anything else. Americans must not allow pro-abortion fanatics to impose their beliefs on the majority." It is one of the great achievements of the evangelical and anti-abortion movement that they have convinced both society and the courts that they are an oppressed minority whose taxpayer dollars must be protected from funding abortion with more dedication than we protect a woman's right to chose.

Women's health advocates remember with horror how the Bush administration attacked reproductive rights with a plan to classify forms of contraception as abortion in order to cut off access to family planning. The episode goes to show that reproductive care is accessible largely at the whim of the sitting president and his administration. Under the Mikulski Amendment, HHS determines what services count as preventative care, and in theory HHS could remove contraception from that list under an anti-abortion president. But it will be harder. Once women begin receiving cost-free contraception, reversing this decision becomes politically difficult.

This is all contingent on the administration's willingness to make the final push for cost-free contraception. Chances are, after taking the long road to make sure these guidelines were based on science and not politics, they won't back down now. Today, 14 million women do not use contraception -- or use it sporadically and ineffectively -- because of the costs; women of reproductive age pay 68 percent more in out-of-pocket health costs than their male counterparts, due mostly to reproductive care. It's hard to stress just how big a deal these changes will be. Advocates have been fighting for universal contraceptive access for decades, and in a year when access to preventative care has been severely rolled back, it's a rare and important win for women.

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