If the federal government takes the Institute of Medicine’s
(IOM’s) advice, every American will soon be required to purchase
health insurance that includes coverage for birth control.
The IOM recently recommended that the government define
birth control — including the controversial “morning after pill”
and the abortion-inducing pill ella — as “preventive
care,” which all insurance providers must cover without copays or
additional fees under the rules of Obamacare.
Some proponents of the definition of birth control as
“preventive care” even say that such a definition would advance
conservative goals, because easier access to the pills
would prevent unwanted pregnancies and abortions, particularly
among low-income women. But will providing free birth control with
every health insurance plan really address these
problems?
A 2002 study published by the Guttmacher Institute
suggests not. The study found that only 12% of women who were not
using contraception and subsequently had abortions from 2000-2001
stated that lack of access to contraception was their reason for
nonuse. (A much more common reason for nonuse was the belief that
the women were at low risk of getting pregnant.)
Dr. Linda Rosenstock, the chairman of the committee
responsible for the IOM’s recommendation, dismissed a questioner’s
concern about this issue during a live Q&A on the
Washington Post website, saying such considerations were
beyond the scope of the committee’s charge.
The notion that free birth control for all would
discourage abortions should also be doubted because distinguishing
between performing a “conventional” abortion and administering the
morning after pill or ella is a dubious
endeavor. Even if abortion rates were to “decline” after the
provision of free birth control, if the use of these pills saw a
corresponding increase, the appearance of decline would be
misleading: Surgical abortions would simply be replaced with
drug-induced ones.
On the subject of unwed mothers’ prominence in poor
communities, an article published by the Heritage Foundation
reports, “Research on lower-income women who have become pregnant
outside of marriage… reveals that virtually none of these
out-of-wedlock pregnancies occurred because of a lack of knowledge
about and access to birth control.”
Thus, the cry from Planned Parenthood’s vice president of
medical affairs, Vanessa Cullins, in a recent New York
Times op-ed that “health insurers continue to charge fees that
make it difficult, sometimes impossible, for women to prevent
unintended pregnancy” may be a little far-fetched.
Moreover, the IOM’s deliberations about birth control may
not have been as neutral as they were made to appear. Although the
purported reason the government consulted the IOM on this issue was
to ensure “nonpartisanship,” Americans United for Life issued a
press release last week reporting that Planned Parenthood — hardly
a disinterested spectator in the “reproductive rights” debate —
was invited to contribute to the IOM’s discussion on whether birth
control should be defined as preventive care. And economist
Anthony Lo Sasso, the one committee member who
dissented from the IOM’s final decision, accused
the organization of taking too subjective an approach to
determining its recommendations.
Lo Sasso writes in his dissent that the committee did not
have sufficient time to effectively review evidence about the
“preventive” services in question. In fact, he states:
… the committee process for evaluation of the
evidence lacked transparency and was largely subject to the
preferences of the committee’s composition. Troublingly, the
process tended to result in a mix of objective and subjective
determinations filtered through a lens of advocacy.
He goes on to call the committee’s “evidence evaluation
process” a “fatal flaw,” especially given the policy significance
of its decision.
Lo Sasso also criticizes the committee for failing to
conduct cost-benefit analysis of mandating coverage for
contraceptives.
In their response to Lo Sasso’s dissent, the other
committee members call his views on the committee’s conduct
“inaccurate.” The response states that cost-benefit analysis was
(again) beyond the scope of its charge. It goes on to emphasize
that the committee members have diverse perspectives and
experience, and that none of them join Lo Sasso in his indictment
of the committee. The five-sentence reply, however, offers no
substantive defense of the evidence evaluation process to which Lo
Sasso objected.
Regardless, the responsibility now resides with the
Department of Health and Human Services to determine whether it
will accept IOM’s recommendation and for the first time mandate
nation-wide coverage of (and taxpayer funding for, insofar as
government money subsidizes those who cannot buy insurance on their
own) a contraceptive.
