Contraceptives Aren’t the Only Important Preventive Service

On Monday afternoon the Secretary of the U.S. Department of Health and Human Services will announce which of the Institute of Medicine’s recommendations the department will adopt.

In late March of 2010, Congress passed the Patient Protection and Affordable Care Act (ACA) more commonly known as health care reform.  The ACA included a provision that requires private health insurance companies to cover certain preventive services without cost-sharing.  In other words, a consumer will pay for these preventive services as part of their premium and will not be required to meet a deductable or pay a co-pay.

The ACA developed the list of covered preventive services from several different evidence based sources.  The full list can be found here.  In addition, the Department of Health and Human Services charged the Institute of Medicine (IOM) with reviewing preventive services that are specific to women.  On July 19th, the IOM released its list of recommendations.

The IOM recommended that health insurance companies cover eight preventive services without cost-sharing.  These recommendations include screening and counseling for domestic violence and coverage of equipment to help women who choose to breastfeed do so successfully.  A brief report and the full list of recommendations can be found here.

The media latched on to only one of the IOM’s recommendations and the headlines trumpeted the possibility of free birth control.  In fact the IOM did not recommend free birth control; instead it recommended that insurance companies use money consumers had already paid in premiums to cover any of the Food and Drug Administration’s approved contraceptives.  This recommendation is significant because it will help women prevent unwanted pregnancies as well as plan and space wanted pregnancies.

However, focusing solely on birth control ignores the importance of the other seven recommendations.  Each of these recommendations will improve health outcomes for women with private insurance and will help lessen health disparities faced by women of color.  I would like to highlight two of the recommendations.

The ACA requires that health insurance companies cover the cost of a pap smear without cost-sharing, but the IOM recommended that they also cover DNA-based testing for women over 30 years of age.  Pap smears and the DNA test are used to check for cellular changes in the cervix caused by the human papillomavirus (HPV) that can lead to cervical cancer.   Access to these tests is especially important for women of color as Latinas have the highest cervical cancer rate in the country and African American women are the most likely to die of cervical cancer.

The IOM also recommended that health insurance plans cover counseling and screening for HIV without cost-sharing.  This is significant because women account for one in four new HIV/AIDS infections in the United States.  Of these newly affected women approximately two-thirds of them are African-American.

Adoption of these recommendations will help ensure that women are better able to access the health care they deserve. The IOM based their recommendations on evidence based information.   Given the enormous benefits of these preventive services, the Obama Administration should adopt each of these recommendations without qualification.


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