I wrote in a previous blog about the importance of understanding confounding by indication and being sure to ask researchers about it when covering observational studies that appear to suggest a particular treatment or intervention might contribute to a specific effect. I’m passionate about this type of study bias because not considering it — which happens a LOT — can lead people to decline otherwise helpful treatments or leave them experiencing more harm and pain because of unfounded fears. Continue reading
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.
ProPublica, which is tracking last-minute rulemaking by the Bush Administration, reports on one rule that would make it more difficult for the Occupational Safety and Health Administration to regulate toxins.
ProPublica, which also links to coverage in The Washington Post and The New York Times, says “OSHA has issued just one significant health standard” in the past eight years – and that it did that under court order.
Another rule the administration is pushing forward is would require federally funded health care facilities to allow employees to refuse to provide services at odds with their moral or religious beliefs, such as abortion.
David G. Savage of the Los Angeles Times reports that “For more than 30 years, federal law has dictated that doctors and nurses may refuse to perform abortions. The new rule would go further by making clear that healthcare workers also may refuse to provide information or advice to patients who might want an abortion.”
Savage writes that the rule, as written, could extend to other procedures, including prescribing birth control or providing artificial inseminination. A lawyer for the National Women’s Law Center said the law also could affect decisions about end-of-life care.