How Health Reform Should Deal with Birth Control

Birth control didn’t make the White House’s new list of required health services—but women shouldn't panic. Dana Goldstein on why the pill may soon be free, and what President Obama must do to ensure politics don’t get in the way.

As conservative activists voice opposition to government-mandated free access to birth control, the Obama administration has left contraceptives off its initial list of preventive services that new insurance plans must provide co-pay-free once the health-care reform law is implemented in September.

But if you're one of the nearly 11 million American women who pay monthly fees of up to $75 for birth-control pills, don't panic yet. It's still likely that, by 2012 or even sooner, we'll have a health-care system that requires birth-control coverage and offers it to many women for free. Here's why.

Many pro-lifers oppose free contraception because what bothers them is not just abortion, but the whole notion of sex without consequences.

Today's preventive-care list is based on previously written recommendations from a group called the U.S. Preventive Services Task Force, a government-convened panel of medical experts drawn from academia and the private sector. The task force dates back to the Reagan administration, but you probably remember it best from its brush with notoriety last fall, after it concluded that annual mammograms aren't cost-effective or medically necessary for women under 50.

Dana Goldstein: The Coming Birth Control Battle That's the sort of thing the Task Force does—it looks at years of medical research to determine what the typical American patient needs from our (bloated, inefficient) health-care system. But because its work is painstaking, it is also incomplete. Though the group recommends STD screening, breast feeding, and prenatal care, it has never weighed in on the far more radioactive subjects of family planning and contraception.

That's why, when the Senate was debating health-care last year, Maryland's fiery and feminist Barbara Mikulski insisted that the task force's recommendations not be the only guide to what would be required from insurance companies after reform. With the support of allies like Sen. Al Franken and even some Republicans—the moderate Mainers Susan Collins and Olympia Snowe and, surprisingly, the prostitution scandal-plagued David Vitter—Mikulski passed an amendment requiring the Department of Health and Human Services to define a whole new category of preventive health care: women's health.

Sometime in the next six to 18 months, HHS will release regulations stating exactly what "women's preventive health care" means and clarifying whether birth-control coverage will be mandated nationwide, as it already is in 27 states. The politics around that process are distressing and distracting; as I've reported, many social conservatives vociferously oppose expanding access to affordable birth control, despite widespread public support for such policies. And although Barack Obama promised on the campaign trail to fight hard for reproductive rights, during the health-care legislative battle, the White House showed little interest in facing down culture-war controversy, and made no strong statements in support of either abortion rights or access to contraceptives.

That said, there is overwhelming support across the public health profession—and among the public at large—for expanded access to contraceptives. After all, half of all American pregnancies are unintended, an epidemic that not only disrupts individual lives, but costs the health-care system an estimated $5 billion annually.

The American College of Obstetrics and Gynecology and the National Business Group on Health already support co-pay-free birth control. More tellingly, way back in 1995, the nonpartisan Institute of Medicine—the same group expected to advise HHS as it defines women's preventive health care— recommended that the U.S. increase the number of insurance plans that cover birth control, and use government money to offset its costs for many more poor women.

That sounds a lot like what reproductive-rights advocates have in mind for the implementation of health reform—and a lot like what candidate Barack Obama supported in July 2007, when he told a Planned Parenthood conference in Washington, D.C., "We should never be willing to consign a teenage girl to a lifetime of struggle because of a lack of access to birth control." Obama promised to fight for "equity in contraceptive coverage" and for a health-care system in which "access to affordable contraception is not just a privilege for the few but an option for all women."

I was sitting in the audience that morning, covering the Democratic primary as a reporter. Later, during the general election, this speech became infamous among Obama's conservative opponents; they posted it on blogs, calling Obama "pro-abortion" and generally hostile to the needs of "unborn life."

The truth, of course, is that the easiest way to bring down the abortion rate is to increase the use of birth control. Yet many pro-life conservatives still oppose free contraception, because what bothers them is not just abortion, but the whole notion of sex without consequences, outside the bounds of traditional marriage.

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Those views ignore the reality of American life in 2010. Here's hoping that political leaders have the guts to ensure that the regulatory implementation of health-care reform doesn't.

Dana Goldstein is an associate editor and writer at The Daily Beast. Her work on politics, women's issues, and education has appeared in The American Prospect, Slate, BusinessWeek, The New Republic, and The Nation.