Healthcare reform fight brewing over family planning

Federal regulators face a tough choice on contraception as they finalize the rules for coverage of preventive services under the healthcare reform law.

The law requires that, starting Thursday, new health plans cover preventative care benefits without deductible, co-pay or coinsurance. The administration unveiled regulations implementing the provision two months ago, and stakeholders had until midnight on Friday to comment.

Back in July, regulators deferred a decision on "preventive care and screening" services specifically for women until August of 2011, prompting Planned Parenthood to declare that it would press for coverage of "all forms of FDA-approved prescription contraception." Stakeholders revisited the issue in their latest filings.

The U.S. Conference of Catholic Bishops raises three main concerns in its objections to coverage of contraception: 

- Family planning is not disease prevention;

- While preventive services are often low-risk options aimed at avoiding risky consequences later, contraceptives can have the opposite profile; and

- Mandating contraception or sterilization coverage poses a threat to the rights of conscience of religious employers and others.

"To prevent pregnancy is not to prevent a disease — indeed, contraception and sterilization pose their own unique and serious health risks to the patient," the group writes. "In addition, contraceptives and sterilization are morally problematic for many stakeholders, including religiously-affiliated health care providers and insurers."

Montana's commissioner of securities and insurance, however, wrote to urge mandatory coverage of "the full range of women's preventive health care needs, including family planning."

"Pregnancy is an expensive proposition and prevention of unplanned pregnancy is highly cost effective," writes Commissioner Monica Lindeen. "For every public dollar invested in contraception, nearly $3.75 is saved in Medicaid expenditures that would have been needed for prenatal care, labor and delivery, postpartum care, and the infant's first year of medical care.

"In addition, the costs of complications can be very high. Women with unplanned pregnancies have more complicated pregnancies and deliveries on average due to increased likelihood of inadequate prenatal care, exposure of the fetus to harmful substances, and low birth weight."

On another note, the National Assembly on School-Based Health Care is urging regulators to ensure students' confidentiality. Plans are required to issue explanations of benefits to policyholders — often a parent or guardian — when paying a healthcare provider, and this can be a problem for sensitive services such as family planning, screening and counseling on sexually transmitted diseases, mental health and substance abuse services.

The American Heart Association also has a host of recommendations, mostly aimed at broadening the scope of services that must be covered without co-pays.