Health Reform Should Require Coverage of Basic Gynecological Well Visits, The Nation Opinion Piece Says

November 3, 2009 — "[J]ust as the prognosis for our health care system is beginning to look sunnier, yet another complication has emerged: so far, reform legislation has failed to require insurers to cover some basic preventive services for women, or prevent providers from charging extra for them," Sharon Lerner, author of the upcoming book "The War on Moms: Life In a Family-Unfriendly Nation," writes in an opinion piece in The Nation. According to Lerner, the bills emerging from Congress do not include provisions that would require health insurers to cover standard gynecological well visits, "leaving essential care such as pelvic exams, domestic violence screenings, counseling about sexually transmitted diseases and, perhaps most startlingly, the provision of birth control off the list of basic benefits all insurers must cover." In addition, none of these services are "protected from 'cost sharing,'" meaning that "women could wind up having to pay for some of these services out of their own pockets," Lerner says.

Although "[n]o one wants the process to collapse under a mountain of requests from special interests groups," women -- who account for half of adult patients -- "are not a special interest group," Lerner continues. Because the House and Senate bills already include lists of services that insurers must cover without requiring additional payment from members, "it's hard to understand why all these services provided in a basic well-woman visit to the gynecologist" are not included on those lists, she adds.

The failure to require coverage of these services demonstrates "the fact that women's bodies have become political lightning rods, even when abortion is not the issue," according to Lerner. Some "senators treat birth control and other basic women's health services as a proxy for abortion," Lerner writes. She notes that a vote in the Senate Health, Education, Labor and Pensions Committee on Sen. Barbara Mikulski's (D-Md.) amendment to require coverage of basic women's health services "went exactly along pro- and anti-choice lines," passing by one vote. "The committee's discussion of the amendment was dominated by Republicans' worry about the possibility of government money winding up in the hands of Planned Parenthood," Lerner says, adding that the House bill (HR 3962) does not include similar language. Adam Sonfield, a Guttmacher Institute policy expert, said, "People equate family planning services with Planned Parenthood, and they equate Planned Parenthood with abortion." The senators who opposed the amendment "either misunderstood or purposely distorted the amendment" to make the vote a referendum on abortion, Sonfield added.

"[T]he irony of letting antiabortion sentiment undercut the coverage of birth control is that it will likely lead to more abortions," Lerner writes. Anne Davis, an ob-gyn and medical director of Physicians for Reproductive Choice and Health, noted that untreated STIs can result in infertility, while pelvic exams help diagnose cervical cancer. "If women can't get this kind of primary care, there are three clear outcomes: cancer, abortions and infertility," according to Davis.

Some congressional Democrats "counsel patience." Lerner writes, "Yet before we resign ourselves to a very imperfect health reform bill, it's worth reminding lawmakers that women's health extends far beyond abortion." While some lawmakers "may fear the consequences of taking a stand for basic services for this half of the population, the cost of not doing it, both in terms of health and politics, is sure to be far greater," she concludes (Lerner, The Nation, 10/30).