Obama Administration Does the Right Thing, Finally, on Contraceptive Coverage

Today, the Obama Administration took a long-overdue stand on women’s rights to basic reproductive and sexual health care by making a final ruling on contraceptive coverage under health reform. The decision requires that the vast majority of employer-based health insurance plans must cover preventive services for women including contraception without charging a co-pay, co-insurance or a deductible. This means all women with health insurance coverage will have access to the full range of preventive services originally recommended by the Institute of Medicine (IOM), including all FDA-approved forms of contraception.

“All women should have access to contraceptive coverage, regardless of where they work,” said Nancy Keenan, president of NARAL Pro-Choice America. “The administration stood firm against intensive lobbying efforts from anti-birth-control organizations trying to expand the refusal option even further to allow organizations and corporations to deny their employees contraceptive coverage. As a result, millions will get access to contraception—and they will not have to ask their bosses for permission.”

“I applaud the Administration for making a decision based on science that greatly expands women’s access to affordable contraceptive coverage,” said Congresswoman Lois Capps (D-CA).

Especially in tough economic times like we are experiencing now, women and their partners often have to choose between high contraceptive costs and paying the bills. Today’s announcement will go a long way in making sure that cost does not prohibit women from planning their pregnancies.

Last August, the Department of Health and Human Services (HHS) issued the initial or “interim” ruling on contraceptive coverage. But the fate of contraceptive care without a co-pay was called into question when the United States Conference of Catholic Bishops (USCCB) and other religious right groups–who are opposed to virtually all forms of reproductive and sexual health services–began a strenuous campaign to over-turn the original interim ruling.  

The stakes were raised when then-Archbishop and now Cardinal Timothy Dolan paid a visit to the White House and held a private meeting with President Obama, during which he apparently pressed hard for an exception for religious organizations so broad it would have left millions of women and couples without insurance coverage for contraceptive care. The original interim ruling exempted all organizations with a specific religious mission from having to cover contraception (e.g. churches) but did not exempt religiously-affiliated businesses and organizations without a specifically religious mission, such as Catholic hospitals, from offering contraceptive coverage. The USSCB wanted an exemption for all religious organizations that oppose contraception, regardless of their mission.

Concern about the Obama Administration’s final decision on contraceptive coverage was heightened when Dolan, in an interview with the New York Times, indicated that the President had expressed sympathy for the “Catholic point of view,” otherwise known as the USCCB point of view, since 98 percent of Catholic women use contraception at some point in their lives. Anxiety rose further after the administration, in a rejection of considerable medical, public health and scientific consensus, over-rode for political reasons the Food and Drug Administration’s recommendation that Plan B One Step emergency contraception be made available over the counter for all females at risk of unintended pregnancy, including those ages 17 and under.

“The bishops pulled out all the stops in their campaign against women’s access to contraception,” said Jon O’Brien, president of Catholics for Choice. “While the refusal clause that is contained in the legislation is still too expansive, denying many women, as it does, affordable access to contraception, we are relieved by this announcement. Catholics for Choice and our colleagues in the reproductive rights movement expended a huge amount of energy and resources mobilizing the public to take action on this pivotal issue. In the final analysis, this was a victory for common sense and scientific advice in the interests of the common good.”

With the final rule on contraceptive coverage, however, women, as noted by the statement from HHS Secretary Kathleen Sebelius, “will not have to fore-go these services because of expensive co-pays or deductibles, or because an insurance plan doesn’t include contraceptive services.”

Moreover, as she noted:

This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.  

According to the Guttmacher Institute, 50 percent of women ages 18 to 34, including Latinas, say there has been a time when cost of prescription birth control interfered with their ability to use it consistently.

HHS did make a concession to the religious right, by giving religious organizations that do not currently provide contraceptive coverage an extra year–until August 1, 2013– to comply with the final rule. HHS stated that employers wishing to take advantage of the additional year “must certify that they qualify for the delayed implementation.”

According to research conducted by the National Latina Institute of Reproductive Health (NLIRH),  Latinas want the full range of birth control options available to them. And, noted NLIRH in a statement, “birth control use is nearly universal in the United States: 99 percent of sexually experienced women will have used birth control at some point in their lives, including 98 percent of sexually experienced Catholic women.”

This additional year will allow these organizations more time and flexibility to adapt to this new rule.  We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support.  We will continue to work closely with religious groups during this transitional period to discuss their concerns.

More than any other factor, it was the anger of women during a presidential election cycle that drove the administration to do the right thing. Scientific and public health evidence are unequivocal on the health benefits of access to contraception. The availablity of birth control enables women to exercise their rights to decide whether and when to bear a child, and by extension, as extensive social science data show, enables women to pursue their educational and economic goals, and to be full members of society.

For these and other reasons, “it is crucial that women have access to affordable birth control to prevent unintended pregnancies, plan the timing and size of their families, and protect their health,” said Judy Waxman, Vice President for Health and Reproductive Rights of the National Women’s Law Center. “The reality is that nearly all sexually active women in the U.S., regardless of their religious beliefs, use contraception at some point in their lives.”

But the evidence and ubiquity of contraceptive use notwithstanding, it took a grassroots movement to override the outsized influence the 270-odd bishops and the religious right have on the White House and Congress when it comes to abortion, contraception, sexual health education and related issues.

“This decision was never a sure thing,” said Cecile Richards, president of Planned Parenthood Federation of America. “For months, anti-women’s health groups and their congressional allies lobbied hard to undermine this important benefit. But after over 100,000 Planned Parenthood supporters spoke out, President Obama stood strong… to protect women’s health.”

The massive outpouring of support for access to birth control we saw over the past few weeks was powerful, it was passionate, and it drowned out the opposition. You and I know that birth control is essential preventive health care. We know that expanding access is one of the most effective ways to reduce the number of unintended pregnancies in America and keep women and their families healthy. We know this is the right thing to do.”

Likewise, NARAL Pro-Choice America sent 135,543 grassroots messages to the Obama administration “calling on the White House to stand strong in support of no-cost coverage of contraception.”

To those concerned about women’s health and rights, and relying on science and evidence as the basis of public policy, this constitutes a huge victory, albeit in a battle that should never have been necessary to wage. For millions of low- and middle-income women seeking to manage the competing demands of family, job, and health care, contraceptive coverage will bring considerable relief, either because they will not lose something they already have, or they will gain coverage for an expense that can run over $600.00 per year and which is unique to them as women.

Nonetheless, at a time when a record number of anti-choice provisions are being introduced in legislatures across the nation, when neither the Administration nor Congress show evidence of consistent strong support for–nevermind understanding of–women’s health and rights, and when numerous presidential candidates are making vilification of reproductive and sexual health care a centerpiece of their campaigns, this is but one victory in a long and ongoing war on women’s lives.

“The battle over this issue is a warning about what is to come,” said O’Brien, “especially as the bishops are playing the victim card in their pleas for special treatment and their false assertions about alleged attacks on religious freedom. The president and Congress will need to get real about what is going on, and remember that this coming November the electorate will not be listening to the bishops, so neither should they.”