The United States Department of Health and Human Services (HHS) recently released sweeping new guidelines for women’s preventive medical services that new insurance plans must cover beginning in August 2012. In addition to expanding the range of procedures that insurers are required to cover, “plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.” The following preventive services must be covered by insurance with no out-of-pocket costs: annual well-woman visits; gestational diabetes screening for pregnant women; DNA testing for human papilloma virus (HPV) in women over age 30; counseling for sexually transmitted infections (STIs); counseling and screening for HIV; contraceptive methods approved by the Food and Drug Administration and contraceptive counseling; counseling, support, and supplies for breastfeeding women; and domestic violence screening and counseling.
These new guidelines are part of a comprehensive overhaul of insurance coverage for preventive services mandated by the Patient Protection and Affordable Care Act (P.L. 111-148), commonly referred to as health care reform legislation. Ensuring access to health services that can prevent chronic health conditions—“which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending”—was a primary focus of health care reform. The legislation mandates that— in addition to services enumerated in the bill— such as mammograms for women over age 40, “[p]reventive services that have strong scientific evidence of their health benefits must be covered [by insurance] and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.” Specifically, “with respect to women,” the bill requires insurance companies to cover, without any out-of-pocket costs, “such additional preventive care and screenings . . . as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.” In response to this directive, HHS charged the independent Institute of Medicine (IOM) to recommend preventive services that are necessary for women’s health and well-being in order to inform the development of comprehensive guidelines for what women’s preventive services health insurance must cover. The IOM established the Committee on Preventive Services for Women, which conducted an exhaustive review of existing preventive care guidelines, expert recommendations, medical research, and public comment. The Committee then proposed the women’s preventive health services guidelines that HHS subsequently adopted.
Out-of-pocket medical costs for preventive care services that are covered by insurance, such as copayments and deductibles, often deter people from accessing services that will ensure their health and well-being. According to the Commonwealth Fund, a private foundation dedicated to improving the health care system, this is especially true of women. Women have “greater health care needs, especially during their reproductive years,” yet even those with health insurance are “far more likely than men to report they had not received needed care because of cost.” Specifically, “in 2010, 48 percent of working-age women—an estimated 45 million people—reported that because of cost they did not fill a prescription; skipped a recommended test, treatment, or follow-up; had a medical problem for which they did not visit the doctor; or did not see a specialist when needed—an increase from 34 percent in 2001.” Mandatory coverage of contraception will ease the burden of health care costs for almost all women of childbearing age, as 93% of women ages 15 to 44 who are at risk of unintended pregnancy use some form of contraception.
The new guidelines also are an important step toward President Barack Obama’s goal of reducing health disparities. For instance, lower-income women will have greater access to these services due to the elimination of any out-of-pocket cost. Counseling and testing for STIs, including HIV, will aid the populations that are disproportionately affected. For instance, African American women are more likely than those from other racial and ethnic groups to die from cervical cancer, which can be caused by HPV, and to contract HIV. Another population group that experiences disproportionate rates of STIs is young women ages 15 to 19. These women have the highest rates of Chlamydia and gonorrhea “compared with any other age or sex group,” and their rates of syphilis infection have risen every year since 2004.
Requiring health care providers to provide domestic violence counseling and screening also is vital to preserving women’s health. Women of all ages are at much higher risk of experiencing intimate partner violence than men. They suffer 84% of spousal violence and 86% of violence from a male or female partner. As health care providers will be required to ask women and adolescents about current and past violence and abuse in a culturally sensitive and supportive manner,” they will have greater opportunities to help women access the supportive services they need to protect themselves from future violence.
HealthCare.gov, “Affordable Care Act Rules on Expanding Access to Preventive Services for Women,” Fact Sheet published 1 August 2011, accessed 29 August 2011, <http://www.healthcare.gov/news/factsheets/womensprevention08012011a.html>.
“Women’s Preventive Services: Required Health Plan Coverage Guidelines.”
Patient Protection and Affordable Care Act, Pub. L No. 111-148, § 2713(a)(4), 112th Congress (2010).
Clinical Preventive Services for Women: Closing the Gaps (Washington, DC: Institute of Medicine, 2011), 1.
Ruth Robertson and Sara A. Collins, Women at Risk: Why Increasing Numbers of Women Are Failing to Get the Health Care They Need and How the Affordable Care Act Will Help (Commonwealth Fund, 2011), accessed 20 August 2011, <http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/May/1502_Robertson_women_at_risk_reform_brief_v3.pdf>, 1, 6.
Family Violence Statistics: Including Statistics on Strangers and Acquaintances (Washington, DC: U.S. Department of Justice, 2005), accessed 29 August 2011, <http://bjs.ojp.usdoj.gov/content/pub/pdf/fvs02.pdf>.
Clinical Preventive Services for Women: Closing the Gaps, 10.