Women's Health Marks Milestone with Implementation of New Preventive Care Benefits

By Louise Chu

Women’s health is marking a significant milestone Wednesday, as a law requiring health insurance plans to provide new preventive care benefits officially takes effect.

Claire Brindis, DrPH, MPH

Claire Brindis, DrPH, MPH

The benefits, adopted last year by US Health and Human Services (HHS) Secretary Kathleen Sebelius, include allowing women access to annual preventive care doctor visits, support for breastfeeding equipment, domestic violence counseling, screening for human papillomavirus and contraception — all covered without a co-pay.

For UCSF’s Claire Brindis, DrPH, MPH, who served on the independent Institute of Medicine (IOM) committee that issued the report outlining eight key recommendations, the changes implemented Wednesday have a “potential rippling effect on not just women’s health but also family’s health.”

“It was an exciting opportunity to serve the nation and to really bring evidence to bear on women’s lives,” said Brindis, the director of the Philip R. Lee Institute for Health Policy Studies and a co-director of the Bixby Center for Global Reproductive Health. She was one of 16 health care experts on the IOM committee that wrote the 2011 report, titled “Clinical Preventive Services for Women: Closing the Gaps.”

“We really looked at where we have previously failed to meet the needs of women and what factors act as barriers to assuring access to health screenings,” she said.

“When we made the recommendations, we really did not know what was going to be the outcome, so it was extremely illuminating that all eight were adopted.”

New Preventive Services for Women Fully Covered by Health Plans Beginning August 1

  • Annual well-woman visits.
  • Gestational diabetes screening that helps protect pregnant women from
  • one of the most serious pregnancy-related diseases.

  • Domestic and interpersonal violence screening and counseling.
  • FDA-approved contraceptive methods, and contraceptive education and
  • Breastfeeding support, supplies and counseling.
  • HPV DNA testing, for women 30 or older.
  • Sexually transmitted infections counseling for sexually-active women.
  • HIV screening and counseling for sexually-active women.

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According to an HHS report released this week, approximately 47 million women are in health plans that must cover these preventive services at no charge. It’s being rolled out as part of the Patient Protection and Affordable Care Act (ACA) signed by President Barack Obama in 2010.

“President Obama is moving our country forward by giving women control over their health care,” Sebelius said in a statement. “This law puts women and their doctors, not insurance companies or the government, in charge of health care decisions.”

Despite cause for celebration, Brindis is cautious about challenges facing the new law, including a provision that allows some insurance providers to avoid implementing the changes for patients currently in plans. Only new and renewing plans must offer the new level of coverage, so it could take years before the benefits reach all women who are entitled to them. Health plans that existed before March 23, 2010, and have not changed substantially,  may take advantage of a "grandfather clause" that won't require them to offer the benefits until 2014.

Brindis also pointed to the ongoing opposition to the ACA in Congress and the potential impact of the November election, as well as ongoing controversy over the provision that requires health plans to provide free birth control to women as part of the preventive benefits package. Courts are currently weighing lawsuits by the Catholic Church and religiously affiliated organizations, which are temporarily exempt from that provision.

“It’s this concern about government mandating the church to cover contraceptive services that is at the root of the controversy," she said. "In fact, a very large proportion of Catholic women report that they use birth control, that they use contraception services, and that they don’t find the use of contraceptives controversial."

As the new benefits roll out, another challenge will be to educate women about these preventive services and measure its real-world impact, Brindis said. Medical and policy experts will be “keeping an eye on what’s the proof, gathering the types of evidence, that incorporating these practices within the provision of health care actually contributes to improved health outcomes for women, as well as decreasing the cost,” she said.

And the work doesn’t stop there. The need to keep focusing on prevention, rather than after-the-fact treatment is more important than ever. For instance, Brindis cited studies showing that for every dollar spent on family planning, nearly 10 dollars are saved within five years.

“Health evidence is constantly being updated,” she said. “We need to have an infrastructure in place that reviews on an annual basis emerging evidence regarding what other preventive services may need to be incorporated into a health benefits package."

Photo by Susan Merrell