The health insurance exchanges at the heart of the Affordable Care Act are still months away, but millions of women across the country are already benefitting from the law.
It has been a year since most employers have been required to offer health insurance that covers basic women's preventive health care services, which means that no matter when a plan year started, women who have employer-sponsored insurance likely now have access to a host of important services without having to make an additional co-payment or meet their deductible.
Coverage of these services was endorsed by a highly respected committee of health care professionals at the Institute of Medicine, who produced an extensive report on the science and statistics behind their recommendations. The services include annual "well-woman" visits; gestational diabetes screening; DNA testing for the human papillomavirus (HPV); counseling on sexually transmitted infections; screening and counseling on HIV; contraception and contraceptive counseling; breastfeeding support, supplies, and counseling; and screening and counseling for domestic violence.
These are all wonderful advances in addressing disparities in women's health. Unfortunately, chances are that most people have only heard about one of them: contraception.
Even though 28 states required contraception coverage long before the Affordable Care Act was passed, opponents of "Obamacare" are using the issue to challenge the law in lawsuits filed across the country. At last count, 69 cases have been filed, 49 are still pending, and few have been decided on their merits.
The challenges are part of a larger legal strategy to re-litigate (really, re-re-re-litigate) the constitutionality of the ACA. As commentators have noted, once challengers get conflicting decisions in different courts, they will then have grounds to appeal the matter to the Supreme Court. (Circuit splits are one of the most common reasons the Court decides to hear a case.)
To read the headlines, the issue sounds like the ultimate dinner party no-no: Sex! Politics! Religion!
In fact -- and I refer you again to the IOM report -- it is all about health.
By the way, opponents who want to argue that it is all about religion are actually arguing that it is all about corporations. Religious freedom is very important, but it is also very personal, and up until now, it has been accepted as a protection for individuals, not corporations. That is why one of the few courts that has reached the merits of the issue wrote that the Religious Freedom Restoration Act "is not a means to force one's religious practices upon others" when it dismissed the employer's lawsuit. And in fact 99 percent of sexually active women -- including 98 percent of women of faith -- have used contraception.
Back to health. For those who truly care about the health and well-being of women and children, the studies cannot be clearer: unintended pregnancies are bad news for both. This is why one of the CDC's public health goals in its Healthy People initiative is to "improve pregnancy planning and spacing and prevent unintended pregnancy." Here's a key excerpt from the initiative's landmark 2010 report:
Medically, unintended pregnancies are serious in terms of the lost opportunity to prepare for an optimal pregnancy, the increased likelihood of infant and maternal illness, and the likelihood of abortion... With an unintended pregnancy, the mother is less likely to seek prenatal care in the first trimester and more likely not to obtain prenatal care at all. She is less likely to breastfeed and more likely to expose the fetus to harmful substances, such as tobacco or alcohol. The child of such a pregnancy is at greater risk of low birth weight, dying in its first year, being abused, and not receiving sufficient resources for healthy development.
A bonus for employers who are focused on the bottom line: saving lives and promoting healthy outcomes is also good for the balance sheet. In fact, a study of large employers found that "it costs employers 15-17 percent more to not provide contraceptive coverage in employee health plans than to provide such coverage, after accounting for both the direct medical costs of pregnancy and indirect costs such as employee absence and reduced productivity." Similarly, every dollar invested in contraception by the government has saved the Medicaid programs $5.68 in averted pregnancy-related care.
Of course, the fact that it is good for business is just a bonus. Health care decisions should be made by individuals in consultation with health care professionals, not by someone in a corporate board room. We would not tolerate our employers refusing to cover antibiotics or blood transfusions, both of which have faced objections on religious grounds. Taking responsibility for one's own reproductive health should be no more controversial.