Florida medical leaders and some religious groups at odds over new women's preventive health rule

Requirements will take effect Jan. 1, 2013

Private health insurance plans will have to cover birth control, well-woman visits, breast-feeding support and domestic violence counseling next year under a new women's preventive health rule announced by the Obama administration Monday.

The rule, implemented under the Affordable Care Act, pleased public health advocates, but touched off outrage among religious and social conservatives because it defined contraceptives to include morning-after pills.

Jupiter-based ob-gyn Dr. John Burigo said co-pay free preventive care will make a difference to his patients. Local health insurance copayments started out at $5 or $10 a visit, he said, but are now so steep that his patients increasingly put off annual their well-woman exams, raising the risk that cancers and other health issues will go undetected.

"It's pricing a certain portion of patients out of the market, particularly for preventive care," said Burigo, with OB-GYN Specialists of the Palm Beaches. "When their copays are $60 or $70, they decide they can put that money toward something else."

Pro-life groups including the Family Research Council vowed to fight in Congress to undo the provision.

"The mandate will include FDA-approved drugs like Ella and Plan B that are misleadingly labeled 'emergency contraceptives' despite the fact that they can actually destroy a developing baby prior to or after implanting in the mother's womb," said Jeanne Monahan, director of the Family Research Council's Center for Human Dignity, in a statement. "This administration is promoting mandates that will violate the consciences of millions."

Besides ensuring co-pay-free well-woman visits and birth control, the new rule requires insurers to cover counseling on sexually transmitted diseases; domestic violence screening and counseling; breast-feeding support; DNA tests for human papillomavirus after age 30, and gestational diabetes testing for pregnant women.

It includes a "conscience exemption" for religious employers who object to contraceptive coverage.

The rule goes into effect in August 2012 and affects only newly written private health plans, not grandfathered ones, and not Medicare and Medicaid.

The rule is based on guidelines proposed by the Institute of Medicine, which last month issued a report recommending co-pay-free coverage of women's preventive services. The group found that more than 85 percent of large employers and 62 percent of small employers already cover FDA-approved contraceptives. Even so, the medical cost of unintended pregnancy is in the billions, they said. Nationwide, 28 states already require contraceptive coverage. Florida is not among them.

Burigo believes requiring co-pay-free insurance coverage for contraceptives makes sense, given the cost of unwanted pregnancies.

"It is a significant cost and has a significant impact on health care," he said. "For patients not interested in becoming pregnant, it is certainly a worthwhile public health investment."

The Florida Catholic Conference disagreed. It was among those urging contraceptives be left off the list of covered benefits, saying they were to blame for the sexual revolution and the accompanying rise in the divorce rate, and the rate of women and children living in poverty.

"Making a full gift of oneself, including a willingness to bear a child with one's partner should a child be conceived, has the effect of strengthening marriage and family life," the Florida bishops wrote.

Health and Human Services Secretary Kathleen Sebelius predicted the co-pay-free preventive care will lead more women to visit the doctor, and save money and lives by catching health problems, including hypertension, cancer, and gestational diabetes during pregnancy, at earlier stages.

"We know this kind of care can prevent illness and improve health, but too many people go without it," she said. "It drives up health care bills for families and businesses by allowing small health care problems to become big ones."

The insurance industry thought otherwise, however, predicting the rules will raise costs, encouraging patients to go to the doctor more often and to seek prescriptions for drugs that are available over-the-counter. The Plan B pill is sold for about $50 without a prescription to women over 17.

"Unfortunately, the preventive care coverage recommendations recently issued by the IOM (Institute of Medicine) would increase the number of unnecessary physician office visits and raise the cost of coverage," said Karen Ignagni, president and CEO of America's Health Insurance Plans.

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