How Donald Trump's Health Secretary Pick Endangers Women - New York Times
Responding to evidence that health plans did not sufficiently take into account women’s unique health needs, the law included preventive care for women on this list of required coverage. But instead of listing every covered service in the act itself, the law left that task to regulators in the Department of Health and Human Services. They, in turn, relied on a study based on a review by the Institute of Medicine (now the National Academy of Medicine) that recommended several categories of services: well-woman visits, screening for gestational diabetes, counseling for sexually transmitted infections, breast-feeding support, screening and counseling for domestic violence, and — most at risk of repeal now — contraceptive methods and counseling.
Recognizing that contraceptive services is a sensitive cultural and political issue, the Obama administration exempted houses of worship from the coverage requirement and created an accommodation for religious nonprofits. This requirement spurred litigation that ended up in the Supreme Court twice and resulted in some for-profit businesses’ being able to opt out of the requirement, too.
Such care goes beyond reproductive health. The only doctor many women see regularly is a gynecologist, and in 35 states OB/GYNs can be a woman’s Medicaid primary care provider.
Moreover, 62 percent of all women of reproductive age use a contraceptive method, and 99 percent of women ages 15 to 44 who have ever had sexual intercourse have used at least one contraceptive method. In contrast, only 18 percent of people between the ages of 18 and 64 visit an emergency room at least once each year. Yet no one doubts the importance of emergency coverage.
Obamacare did not invent the use of legal mandates to cover contraception. Before its enactment, 28 states required contraception coverage, and 85 percent of large employers provided it. The United States Equal Employment Opportunity Commission declared in 2000 that any health plan that covered drugs, devices and preventive care but that did not cover contraceptives violated the Pregnancy Discrimination Act.
So even if the new health secretary were to repeal the law’s contraceptive coverage requirement, many insurance plans would still cover it. But state contraceptive coverage mandates don’t reach everyone, and they don’t address costs. Women in the 22 states without a mandate or working for the employers that did not cover contraception before the Affordable Care Act would have to pay the full cost on their own.
Women know what is at stake. That is why they have been rushing to see their doctors and to fill prescriptions before Mr. Trump takes office in January.
Paradoxically, cutting women’s health care services is contrary to Republican goals. House Speaker Paul D. Ryan’s health plan states, “Prevention requires efforts and investments today that are expected to provide long-term cost savings and other benefits.” That is exactly what covering contraception does: provide women significant benefits to their health and socioeconomic status, while in many cases saving money for the health care system over all. Voters understand this. A majority of people, including two-thirds of women, support private health plans’ covering the full cost of birth control.
Mr. Trump himself has said, America needs “a patient-centered health care system that promotes choice, quality and affordability.” Women will be better off if the president-elect and his health and human services secretary follow this advice.
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