As health insurance companies try to determine what the new health care reform law will require them to cover, birth control is emerging as one of the more controversial issues at stake.
A panel of experts meets for the first time next week to determine whether both public and private health plans should cover the entire cost of contraception. Several medical and women's groups say women should have access to free birth control, but the Catholic church is fighting the idea.
When Congress passed the health care law earlier this year, then-Speaker of the House Nancy Pelosi and Maryland Sen. Barbara Mikulski proclaimed that being a woman was no longer a pre-existing health condition. Under the new law, insurers could no longer charge higher premiums to women simply because they're women.
But Planned Parenthood's CEO for Minnesota, North and South Dakota, Sarah Stoesz, said the law won't achieve gender equality until it requires insurers to cover the full cost of prescription birth control, including co-pays and deductibles.
"[Women] understand the injustice of having to pay for [birth control] when men are not similarly required to make large out-of-pocket expenses to maintain their own health," she said.
Private insurance co-pays for contraception vary widely from about $10 to $50 per month. If a woman uses prescription birth control for 25 years, her total out-of-pocket costs can range from $3000 to $15,000. The cost for low-income women on Medicaid is between $1 and $3 per month.
But the Guttmacher Institute, a think-tank focused on sexual and reproductive health issues, found in a 2007 survey that a third of all women taking prescription contraceptives regularly had to either forgo or delay using birth control because they couldn't afford it.
The Institute's Adam Sonfield said almost half of unintended pregnancies are among women who have gaps in using birth control.
"Those types of problems which aren't exclusively the result of cost but are sometimes the result of cost are pretty important in terms of effective contraception use," Sonfield said. "So this provision is one more way of trying to reduce those barriers."
The health care law says if contraception is covered fully, it will have to be deemed as preventive care, along the lines of mammograms and vaccines. But that's anathema to the U.S. Conference of Catholic Bishops, an influential group that nearly derailed passage of the health care law because of concerns it would cover abortions. The organization sent a letter to the Department of Health and Human Services, outlining their objections.
Spokesman Richard Doerflinger said pregnancy is not an illness or disease and the government should not mandate that all health plans cover contraception when some people paying for those plans might have a religious or moral objection to it.
"Preventive services are the services that are going to be required," he said. "And it's not that it'll be free; it'll be free of co-pay for those that want that coverage, which means it'll be subsidized by those who don't want the coverage."
Doerflinger said the group doesn't want the health care law repealed because it will expand health care coverage to so many who currently don't have insurance. Nonethleless, he said the conference will work with Congress to see if there is a way to legislatively carve out an exemption for organizations and employers that object to paying for birth control coverage.
In the wake of the recent elections, Senate Majority Leader Harry Reid said if the health care law needs tweaking, Congress will do some tweaking. Doerflinger said allowing Catholics to opt out of covering birth control, is, as he put it, "a good tweak to consider."