There’s More To Women’s Health Than Contraception
If you have been listening to the contraception debate in Washington (sort of hard to avoid, isn’t it?), you may be under the impression that preventive health for women equals contraception. Or contraception equals women’s preventive health. (We’re putting aside, for the purpose of this post, the debate about religion, conscience and the role of government).
The Senate has defeated one bid to overturn the administration rule requiring employers to provide an insurance plan with first-dollar coverage of birth control, and it’s not clear what the House will do. But the issue is likely to percolate in Washington, state legislatures and the courts for some time to come.
The health reform law, and the regulations being developed to implement it, has a far more expansive definition of prevention and what it means for women’s health. Here are more details on the new regulations and a tutorial from Kaiser.edu. According to the new women’s preventive health rule, new health plans must cover, without cost-sharing, a lot more than the pill:
- well-woman visits;
- screening for gestational diabetes;
- human papillomavirus (HPV) DNA testing for women 30 years and older;
- sexually-transmitted infection counseling;
- human immunodeficiency virus (HIV) screening and counseling;
- FDA-approved contraception methods and contraceptive counseling;
- breastfeeding support, supplies, and counseling; and
- domestic violence screening and counseling.
These requirements will go into effect in August (with another year allowed to finalize how the religious exemptions will work). Grandfathered plans won’t have to follow the new rule, while they maintain their “grandfather” status. Over time, many health plans will go through changes that will mean that they will no longer be “grandfathered.” Then they too will have to follow the new regulations.
Of course, more women will get these benefits, simply because more women will be insured. Approximately one in five women of reproductive age is currently uninsured. Most of them will get coverage, including preventive services, starting in 2014 whether through Medicaid, through subsidized coverage in the exchanges or by buying coverage. Right now, coverage of maternity benefits is spotty on the individual insurance market, but the plans in the health exchanges will cover it.
The law also requires many other preventive services – some free – for men, women and children. They have not gotten much attention in the polarized birth control debate.
The conversation (and press coverage) about the contraceptive rules have included lots of misinformation about abortion. Politicians who misstate policy don’t help, but reporters need to know what the law does and does not do.
The health law does not mandate abortion coverage and this preventive health rule does not change that. In fact, states under health reform have the explicit ability to limit abortion coverage in policies sold in state exchanges and several have already taken action to do precisely that. Plans that do cover abortion in the exchange will have to wall that off in a way to keep it apart from the federal subsidies.
A few more stray but relevant facts:
According to the Kaiser.edu materials, about two-thirds of women aged 15 to 44 use contraception – and do so for about 30 years.
Most employer-based insurance plans do cover contraception, though there are often co-pays. Among large employers, more than 80 percent cover contraception.
Federal Medicaid dollars do not cover abortion under the Hyde Amendment (except for rape, incest or when the life of the mother is in danger) – although some states use their own money to cover abortion in some circumstances. But Medicaid does cover contraception. In fact, Medicaid pays for more than 70 percent of publicly financed family planning services.
And Title X funds family planning clinics (created in 1970 under the Nixon presidency). According to HHS, about 5 million women and men get family planning services through more than 4,500 community-based clinics. Someone with religious objections to providing contraceptives for employees is indirectly paying for Medicaid birth control coverage – and indirectly for the tax subsidies of employer-sponsored insurance – just as we all pay taxes that fund some things we agree with and some we don’t.
By: Joanne Kenen, Association of Health Care Journalists, March 1, 2012
Contraception Primer: Here’s How It Works Guys
I am not going to link to the Rush Limbaugh “slut” comment. I have too busy a day ahead to spend the next six hours furiously scrubbing myself in the shower whilst rocking and weeping.
I will, however, attempt a substantive point, since this idea that young women are having so much sex they are going broke and want taxpayers to bail them out seems to be solidifying into an actual, real-life meme (which is a bit astounding given what year it is).
That’s just not how it works! Reading the comments that have been made recently, you get the sense that the people—mostly older guys—puking out these sorts of arguments haven’t quite grasped the basics of circa-20121960s contraceptive technology.
So, to all the people making this argument: Hi! Here’s a quick primer. This debate is mostly about the pill, not condoms. It’s not the case that every time a woman has sex she has to take a pill (though something like that also exists for emergency situations, and I’m aware that this enrages you). Rather, women get a prescription for these things called birth-control pills that are generally taken every day. So it’s a fixed prescription cost, and like many such costs, if insurance doesn’t cover it it can get out of hand really quickly because our medical system is an octopus riding a donkey riding a skateboard into a sadness quarry. But there is no proportional relationship between the amount of sex a woman has and the number of standard birth-control pills she consumes. Why, there are even women who aren’t sexually active who take the pill for medical reasons. Whoa!
I know this is a lot to take in all at once, guys. But there are plenty of online resources available if you have any questions.
By: Jesse Singal, Washington Monthly, Political Animal, March 1, 2012
Susan “Lucy” Collins: The Tragic Death Of “Centrism” In Washington
As I’ve been noting here, one of the key things to watch for in today’s vote on the Blunt amendment is how many Republicans defect from the party’s support for it. On the Senate floor just now, one of the key “centrists” that Dems were watching, Susan Collins, announced she will vote for it.
“I feel that I have to vote for Senator Blunt’s amendment, with the hope that its scope will be further narrowed and refined as the legislative process proceeds,” Collins said, vaguely accusing both sides of “playing politics” with the issue.
Collins had been undecided, and the reason she offered for supporting the Blunt measure is that she had asked the Obama administration for further clarification on how Obama’s contraception mandate compromise — which would be undone by Blunt — would impact self-insured religious organizations. She claimed the answer provided by the administration was insufficient.
The question, of course, is whether any answer would have been sufficient. Given Collins’ repeated role as Lucy to the Dems’ Charlie Brown, it’s fair to ask whether this was merely an excuse to cast the Yes vote on Blunt that she would have cast no matter what reassurances the administration offered.
And this goes to the heart of another debate that’s been raging of late. Olympia Snowe’s announced retirement has prompted a great deal of hand-wringing about how supposed “centrist” politicians no longer have any meaningful role to play in Washington. The demands for ideological purity on both sides, we’re told, have grown so strident that the possibility of bipartisan compromise has vanished.
But here you have a case where one of these “centrists” decided not to opt for the compromise position, and instead is going with the extreme one. Obama’s compromise is supported by six in 10 Americans, including 62 percent of independents, according to a new Kaiser poll. The Blunt position, by contrast, is the ideologically rigid one.
If there is no longer any “center” in Washington, it’s because “centrist” Republicans are not embracing solutions that are actually centrist. If bipartisan compromise is no longer possible in Washington, it’s because “centrist” Republicans are embracing the uncompromising positions, rather than the ones that represent genuine compromise.
By: Greg Sargent, The Washington Post Plum Line, March 1, 2012
“The Second Coming”: Women Don’t See GOP’s War On Contraceptives As About Religion
Some Republicans thought the fight over birth control coverage would cost President Obama the election. Instead, it may have unleashed a second coming of the Anita Hill controversy, alienating women who otherwise might be attracted to a fiscally conservative, small government message.
The Obama administration looked weak at first when the Catholic Church balked at regulations requiring religious-affiliated institutions such as universities and hospitals to cover birth control under their employees’ health insurance. The White House had not lined up women to defend birth control as a critical part of preventive healthcare, so the chaste church elders dominated the dialogue, presenting it as an issue of religious liberty. The idea that women had the liberty, as well, to decline the rules offered by the church—particularly in cases where the female employees did not practice Catholicism—took longer to emerge.
But now, lawmakers at the state and federal level (along with presidential candidates) are continuing to hammer away at the issue, and it’s a dangerous game. The Senate today voted down a bill that would allow any employer to deny healthcare coverage of anything if it violates his or her moral principles, a standard so broad it invalidates any federal health insurance standards (which may well be the point). Even if the law were limited to religious teachings only, what would prevent a business owner who is a Jehovah’s Witness from denying coverage of transfusions? Or a Christian Scientist from denying coverage of any kind of medicine at all?
As if on script, supporters of the bill say, “It’s not about contraception,” and it is this repeated comment that stands to get them into the most trouble with female voters. If you’re not of the gender that can get pregnant, you have the luxury of seeing the issue as theological. If you stand to lose control over your life and future because you can’t prevent yourself from becoming pregnant, it is indeed all about contraception. The lecture sounds particularly annoying to a woman when it is being made by men, as has largely been the case on the moral exception bill. It’s the same as when male lawmakers were so utterly baffled and skeptical when Anita Hill told a story of sexual harassment that has been shared by so many, many other women.
Virginia state lawmakers took it even further, considering a bill that would have required women to have ultrasound exams before getting an abortion. Many women found the whole basis of the bill to be fairly insulting, since it suggested that women really have no idea what goes on in their bodies and need to be schooled about it before having an abortion. That could be the only reason a woman would seek an abortion, the thinking went—she simply was too simple or ignorant to know what she was doing. But the mostly male lawmakers knew.
Except that they didn’t. Remarkably, in seeking to teach women about their own bodies, they hadn’t done much learning on their own. They did not know that the jelly-on-the-belly sonogram that makes for such touching scenes in movies is not done in the first trimester of pregnancy (when the vast majority of abortions are performed) because the pregnancy hasn’t developed enough at that point to see anything. Women at that stage of pregnancy must undergo a “transvaginal probe,” an invasive procedure. The phrase itself made some lawmakers so uncomfortable that they didn’t want it uttered aloud during debate, so as not to offend the young pages. The bill was watered down somewhat, so that women would not have to endure a procedure critics described as state-sponsored rape. But the guts of the bill passed the state Senate and are making their way to the governor, who will sign it.
The contraception legislation may well do what it was intended to do—shore up the social conservative base of the Republican party and convince some people that Obama or Democrats are antireligion and pro big government. But proponents also risk energizing a group of women who long ago earned the right to control the size and timing of their families. For those women, it is, indeed, all about contraception.
By: Susan Milligan, U. S. News and World Report, March 1, 2012
Mitt Romney Says He Opposes “Blunt-Rubio Contraception Bill”, But His Campaign Says Otherwise
Republican presidential candidate Mitt Romney told a reporter Wednesday that he opposes a measure being considered by the Senate that would allow employers to decline to provide contraception coverage to women.
“I’m not for the bill,” Romney said during an interview with Ohio News Network reporter Jim Heath. “But, look, the idea of presidential candidates getting into questions about contraception within a relationship between a man and a woman, husband and wife, I’m not going there.”
However, Romney’s campaign quickly denied that the governor opposes the so-called Blunt bill, charging that the question Heath asked was confusing.
“Gov. Romney supports the Blunt bill because he believes in a conscience exemption in health care for religious institutions and people of faith,” Romney spokeswoman Andrea Saul said in a prepared statement.
The differing accounts came on the eve of a planned Senate vote on the Blunt amendment, which has prompted contentious debate both on and off Capitol Hill.
The amendment is intended to overturn Obama administration regulations that would require most health insurance plans to provide FDA-approved contraceptives and sterilization services with no additional copayment or deductible.
But critics argue that the amendment is so broadly written — allowing opt-outs for those with “religious or moral objections” — that it would let employers decline to provide virtually any health benefit for virtually any reason.
Heath, reached by phone at Ohio News Network offices in Columbus, said his question to Romney was clearly asked and was specifically about the Blunt amendment.
“I explained the bill as allowing employers to deny female contraception coverage,” Heath said, characterizing the governor’s statement of opposition as “exactly what he said.”
“What I immediately thought, in all honesty,” Heath said, “was that he was pivoting toward the middle, toward women voters” who may have been put off by Romney rival Rick Santorum’s anti-contraception views.
“I wasn’t expecting a definitive answer,” Heath said. “But having been covering this campaign for months now, I thought he must be looking at Ohio and beyond, and how Santorum has been raked over the coals on this issue.”
“It was a very definitive response, combined with a slap at Santorum,” Heath said. “I was surprised he went there.”
Here’s a transcript of the part of the interview that’s in dispute:
HEATH: “He’s brought contraception into this campaign. The issue of birth control, contraception, Blunt-Rubio is being debated, I believe, later this week. It deals with banning or allowing employers to ban providing female contraception. Have you taken a position on it? [Santorum] said he was for that, we’ll talk about personhood in a second; but he’s for that, have you taken a position?”
ROMNEY: “I’m not for the bill, but look, the idea of presidential candidates getting into questions about contraception within a relationship between a man and a women, husband and wife, I’m not going there.”
HEATH: “Surprised that he went there?”
ROMNEY: “You know, I made it very clear when I was being interviewed by George Stephanopoulos in a debate a while ago: Contraception is working just fine, let’s just leave it alone.”
HEATH: “And the Personhood Amendment could potentially be on the ballot in Ohio this fall. What’s your position on this effort, personhood?”
ROMNEY: “Well it’s interpreted differently by different states, so I’d have to look at the particular provision. We had a provision in my state that said that life began at conception, that’s a provision that I protected. The legislature passed a bill saying that no longer would life be determined to begin at conception, I vetoed that. So we can have a provision that describes life beginning when it in fact begins. At the same time, allowing people to have contraceptives.”
Update at 7:45 p.m. ET: The Romney campaign released audio and transcript in which it directly addressed the earlier comments. Romney made the comments on the Howie Carr Show on Wednesday.
Here’s the transcript:
CARR: Listen I got to ask you here about there’s a — the Washington Post has got a blog out here, saying that Jim Heath, a reporter for a TV station in Ohio just tweeted a remarkable piece of news: Mitt Romney told him he does not support the Blunt amendment which would empower employers and insurers to deny health coverage they find morally objectionable. What happened here, did you –
ROMNEY: I didn’t understand his question, of course I support the Blunt amendment. I thought he was talking about some state law that prevented people from getting contraception so I was simply — misunderstood the question and of course I support the Blunt amendment.
CARR: Okay so that should be taken off the table.
ROMNEY: Yeah.
CARR: That’s running around the world in ten seconds as you know that’s how these things go.
ROMNEY: Yeah exactly right. No, I simply misunderstood what he was talking about. I thought it was some Ohio legislation that — where employers were prevented from providing contraceptives, and so I talked about contraceptives and so forth, so I really misunderstood the question. Of course Roy Blunt who is my liaison to the Senate is someone I support and of course I support that amendment. I clearly want to have religious exemption from Obamacare.
CARR: And Rubio is one of your potential vice-presidential candidates is also — his name is also attached to the bill and Scott Brown here in Massachusetts is supporting it as well.
ROMNEY: Yeah exactly, I think every republican is supporting it, and I actually understand that, I may be wrong on this, but my recollection is that Ted Kennedy even wrote a note to the Pope about religious exemptions from matters of this nature for purposes of conscience. So this is something I really think all Americans ought to be able to get around this religious exemption.
CARR: Yeah well you haven’t been around here lately but that’s been a big controversy here with patches Kennedy saying that you know – telling Scott Brown well you can’t use my father’s letter to the Pope cause he was just sending a letter to the Pope he didn’t really believe anything he said in the letter. I mean that’s what it boiled down to.
ROMNEY: I must admit I hope that when you send a letter to the Pope you believe what you wrote in it.
By: Liz Halloran, NPR News, February 29, 2012
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