Addendum to Drug Survey: Hormonal Birth Control

A couple of weeks ago I posted an article on hormonal birth control. In this article I discussed some of the chemical components of the drug, the side effects, and some of the ethical issues. A friend of mine pointed out that I did not mention the Affordable Care Act (ACA), but many of my readers probably have the ACA and its regulations on birth control on their minds. In this post, we will discuss birth control with respect to the Affordable Care Act. The ACA was about 1000 pages. Blog posts are usually less than 1000 words. Space and patience (both my patience and the reader’s) does not permit me to go into detail on the specifics of the ACA.


One of the provisions in the ACA is that insurance providers cover “preventative services” for policy-holders at no cost at the time of the medical visit. For women, this mandates the availability of zero deductible (essentially free) contraception options. The Health Resources and Services Administration (HRSA) is the government agency that determines what constitutes “preventative services.” As of February 15, 2012, the following preventative services are covered by insurance providers: Well-woman visits, screening for gestational diabetes, human papillomavirus testing, counseling for sexually transmitted infections, counseling and screening for human immune-deficiency virus, contraceptive methods and counseling, breastfeeding support, supplies, and counseling, screening and counseling for interpersonal and domestic violence. Religious employers are excused from the contraceptive mandate for one year. The contraceptives include hormonal contraceptives (preventing pregnancy), sterilization methods, as well as abortifacients such as, Plan B, which serves to chemically abort a pregnancy soon after conception.


There are many ethical issues with this mandate. This disrupts state mandates that are already in place. This mandate does not respect an employer’s right to conscience. There are also issues with fiscal responsibility – who will pay for these “zero-deductible” preventative services?


One issue that concerns me is a federal mandate for insurance companies to cover optional medications or treatments that are typically given to otherwise healthy individuals. It is one thing to require treatment or medications that are life saving. It is reasonable to require coverage for pain management. It is a different matter to require coverage for something that actually impedes normal, healthy function. The argument is that this falls under preventative care, a category which is not terribly contentious. Most people today understand that things like going to the doctor, going to the dentist, exercising and eating right, and education can prevent disease and promote overall health. What constitutes preventive care, however, can easily become a debatable issue. By way of example, in many states, personal training sessions are not covered under preventative care, even though weight training has been shown to prevent the onset of debilitating diseases such as arthritis and osteoporosis, and can serve to manage other diseases such multiple sclerosis. This does not include the health benefits of exercise in general, such as preventing diabetes and heart disease. The ACA, as far as I know, does not mandate insurance companies to cover personal training sessions.


The ACA, however, mandates coverage for contraception, because, apparently, an unwanted pregnancy is a health issue deemed important enough to be included in a government mandate.  There is something circular about insurance companies being required to cover the prevention of a “condition” as well as the promotion of the same “condition” (i.e. wellness, OB/GYN visits, etc). The other items that fall under “preventative care” tend to be conditions that people do not (or should not) want, such as HPV or HIV, and can be prevented through education and behavioral changes. Pregnancy is wanted or not wanted depending a particular persons’ desires, health, or lifestyle. If we take this to its logical end, then how many other personal, optional decisions should insurance providers cover? Even if we grant that insurance providers should cover pregnancy prevention for health reasons, most people who use contraceptives are healthy individuals, and usually, it is because of their healthfulness that they require contraceptives.


I am NOT saying that contraceptives should never be covered by insurance. I am only arguing that it contraceptives seem to fall in an “optional” category for insurance providers, and should not be required by the federal government. I have maintained that drugs that are not used for curing disease should be held to a different standard when it comes to weighing the benefits and risks. We covered sleeping aids (Ambien), over-the-counter allergy medicines (Claritin D and Zyrtec), and sunless tanners (dihydroxy acetone). Hormonal contraceptives, while they can have some therapeutic benefits, are optional drugs that do not serve to cure a disease, and therefore should be held to a different standard when weighing benefits and risks. This is particularly true for hormonal contraceptives because there are non-hormonal and non-prescription options for birth control. In the same vein, contraceptives should be placed in a different category from those treatments that prevent disease.

*Information on the Affordable Care Act was taken from Dan McConchie’s presentation at the CBHD conference, which Cody reported on here.

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