She’s Gotta Have It: 8 ‘No-Cost’ Women’s Health Services Now Available

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Liz Pugh, 23, is a recent college graduate with a job at a nonprofit AIDS advocacy group and financial independence for the first time in her life. Every month she shells out $15 or so of her modest salary for a co-pay on her birth control pills. But no more. The next time she runs out to the pharmacy to resupply, there will be no additional cost. “I am relieved,” she said. “to see that $15 co-pay gone.”

On August 1, insurers for the first time in history were required to start providing women with a set of basic preventive health services — not just birth control — for no extra fee. Though contraception and some of the other newly covered services, such as breast feeding support and equipment, have received most of the media and political attention, the new coverage spans a range of screening, counseling and other health services for women of all ages.

The new provisions fall under the federal Affordable Care Act and, according to Dr. Paula Johnson, Chief of the Division of Women’s Health at Brigham and Women’s Hospital in Boston, “represent a paradigm shift from a health care system built on diagnostic treatment of disease toward a foundation of disease prevention and wellness promotion.”

Johnson is a member of the Institute of Medicine Committee on Women’s Health Preventive Services — the group that recommended the new services be covered — and Executive Director of the Connors Center for Women’s Health and Gender Biology at the Brigham. She says that “cost has been a significant barrier for women” in accessing these basic medical services, and the new requirements “will allow women to get the preventive care that they need without the financial worry.” Moreover Johnson says, having these eight new services covered by insurers “raises the bar for preventive care for women,” and will ultimately strengthen the bond between doctors and patients.

Here, Johnson summarizes the 8 services women with private health insurance will now have access to without cost-sharing, and why these tests and services are vital for overall health:

1. Well-woman visits: Half of women delay or avoid well-woman preventive services due to cost barriers.

2. Screening for gestational diabetes: Gestational diabetes affects 1 in 20 pregnant women with 18% higher associated health care costs.

3. Human papillomavirus (HPV) testing: HPV, associated with many conditions including cervical cancer and head and neck cancers infects one in four U.S. females with direct costs of $3.6 billion annually.

4. Counseling for sexually transmitted infections: Nineteen million new occurrences of STIs emerge each year at an estimated annual cost of $17 billion.

5. Annual counseling and screening for HIV for all sexually active women: Women represent one in four HIV cases. Lifetime direct medical costs are about $1 billion or between $73 million and $93 million annually.

6. Contraceptive methods and counseling for all women with reproductive capacity: Nearly half of U.S. pregnancies are unplanned resulting in three million pregnancies each year and a cost of $19 billion annually.

7. Breastfeeding support, supplies, and counseling: Breastfeeding helps reduce Sudden Infant Death Syndrome, chronic childhood conditions and lowers the risk of breast and ovarian cancers in mothers. If 80 percent of mothers breastfed their children exclusively for the first six months of life, the U.S could save 741 lives and $10.5 billion annually.

8. Screening and counseling for interpersonal and domestic violence (IPV): One in three women will report IPV in their lifetime. Millions of women in the U.S. are abused by their partners each year at a cost of over $5 billion annually.

Johnson makes the fairly obvious but important point that nothing in health care is truly free. “We all pay premiums, we contribute to the cost of our care,” she said. “The difference here is that this takes away the additional cost burden of having a co-pay.” And, of course it only applies to women with private health insurance.

In some states, like Massachusetts, women already received some of these benefits. As Johnson noted in an earlier post on this topic:

The ACA enhances Massachusetts’ existing benefits in two important ways. First, the federal law eliminates consumer cost-sharing for some of Massachusetts’ mandatory women’s health benefits like contraception and pap smears. Commonwealth Care has voluntarily covered contraception without cost-sharing since Summer of 2011, and now most employer-sponsored plans and Commonwealth Choice Plans will follow suit. Second, the ACA provides Massachusetts women with additional mandatory benefits, including well woman visits, breastfeeding support, gestational diabetes screening and screening for interpersonal violence. Overall, the U.S. Department of Health and Human Services estimates that 1,212,350 women in Massachusetts will have guaranteed access to these additional preventive services without cost-sharing for policies renewing on or after August 1, 2012. While Massachusetts women continue to gain access to preventive care under health reform, many women in other states may not be as fortunate.

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