The Obama administration is examining whether the new health care law can be used to require insurance plans to offer contraceptives and other family planning services to women free of charge.
Such a requirement could remove cost as a barrier to birth control, a longtime goal of advocates for women’s rights and experts on women’s health. But it is likely to reignite debate over the federal role in health care, especially reproductive health, at a time when Republicans in Congress have vowed to repeal the law or dismantle it piece by piece. It is also raising objections from the Roman Catholic Church and is expected to generate a robust debate about privacy.
The law says insurers must cover “preventive health services” and cannot charge for them. The administration has asked a panel of outside experts to help identify the specific preventive services that must be covered for women.
Administration officials said they expected the list to include contraception and family planning because a large body of scientific evidence showed the effectiveness of those services. But the officials said they preferred to have the panel of independent experts make the initial recommendations so the public would see them as based on science, not politics.
Many obstetricians, gynecologists, pediatricians and public health experts have called for coverage of family planning services, including contraceptives, without co-payments, deductibles or other cost-sharing requirements.
Dr. Hal C. Lawrence III, vice president of the American Congress of Obstetricians and Gynecologists, said contraceptives fit any reasonable definition of preventive health care because they averted unintended pregnancies and allowed women to control the timing, number and spacing of births. This, in turn, improves maternal and child health by reducing infant mortality, complications of pregnancy and even birth defects, said Dr. Lawrence, who is in charge of the group’s practice guidelines.
But the United States Conference of Catholic Bishops and some conservative groups, including the Family Research Council, say birth control is not a preventive service in the usual sense of the term.
“Pregnancy is not a disease to be prevented, nor is fertility a pathological condition,” said Deirdre A. McQuade, a spokeswoman for the bishops’ Pro-Life Secretariat. “So birth control is not preventive care, and it should not be mandated.”
About one-half of pregnancies in the United States are unintended.
Kathleen Sebelius, the secretary of health and human services, last month unveiled a 10-year plan to improve the nation’s health. One goal of the initiative is to “increase the proportion of health insurance plans that cover contraceptive supplies and services.”
The Department of Health and Human Services commissioned the Institute of Medicine, an arm of the National Academy of Sciences, to help identify preventive services for women that must be covered at no cost under the health care law. The institute, a nonpartisan, nongovernmental organization, seeks to provide unbiased advice to decision makers and the public.
Using this advice, the department expects to issue “comprehensive guidelines” for women’s preventive care by Aug. 1.
A White House spokesman, Nick Papas, said it was too early to comment. “We will wait and see what the study returns,” he said.
Congress left it to the administration to define the preventive care benefit and adopted an amendment by Senator Barbara A. Mikulski, Democrat of Maryland, requiring officials to pay special attention to the “unique health needs of women.”
Lawmakers said they also meant to require coverage of annual checkups and health assessments known as well-woman visits; screening for domestic violence, heart disease and breast and cervical cancer; and doctor visits for women intending to become pregnant.
In a report more than 15 years ago, the Institute of Medicine said financial barriers to contraception “should be reduced by increasing the proportion of all health insurance policies that cover contraceptive services and supplies, including both male and female sterilization, with no co-payments or other cost-sharing requirements.”
Brand-name versions of oral contraceptives can cost $45 to $60 a month or more, not including the cost of a doctor visit for a prescription. In recent years, many health plans have increased co-payments for prescription drugs, so even women with insurance may end up paying half the cost of birth-control pills.
Administration officials and Democrats in Congress said free preventive care was just one of the health care law’s benefits for women. It also prohibits insurers from charging women more than men of the same age for the same coverage. Such disparities have been common. As a result, premiums for women have often been 25 percent to 50 percent higher than those for men.
Advocates for women’s health, including the Planned Parenthood Federation of America and the American Congress of Obstetricians and Gynecologists, have urged the administration to require coverage at no cost for family planning, including contraceptive drugs and devices.
Likewise, the American Academy of Pediatrics said, “Adolescents and adult women need to have access to the full menu of contraceptive methods without cost-sharing,” along with counseling and education.
This recommendation is supported by the American Civil Liberties Union, the March of Dimes, Naral Pro-Choice America, the National Partnership for Women and Families, the National Women’s Law Center and scores of Democrats in Congress.
But Ms. McQuade of the Catholic bishops’ conference said any requirement for coverage of contraception could violate the “rights of conscience” of religious employers and others who had moral or religious objections to it. This concern is amplified, she said, by the fact that some emergency contraceptives can act like abortion-inducing drugs.
Jeanne Monahan, the director of the Center for Human Dignity at the Family Research Council, said: “The government should focus on services that prevent disease. Fertility and babies are not diseases. Fertility occurs in healthy women.”
The issue is also complicated by privacy concerns.
Dr. Margaret J. Blythe, a professor of pediatrics at the Indiana University School of Medicine, said some adolescents would be reluctant to use a preventive care benefit unless the government and insurers guaranteed the confidentiality of family planning services and screening for sexually transmitted infections.
When a doctor or a clinic files a claim, the insurer is often required to send an explanation of benefits to the policyholder, often a parent, describing the services provided. Parents sometimes learn from such notices that their children are sexually active.
Doctors said the need for confidentiality was even greater now because, under the new law, many young adults could stay on their parents’ policies until age 26.
Isabel V. Sawhill, an economist at the Brookings Institution who has studied unintended pregnancy for three decades, said: “It’s absolutely critical that family planning be considered a preventive service. It could prevent all kinds of health problems, and it would actually save taxpayers money.”
“We have rigorous evidence that every dollar invested in family planning saves more than a dollar in welfare and social service costs for children that result from unintended births,” Ms. Sawhill said.