By Magda G. Peck, ScD
Founding Dean and Professor, Joseph J. Zilber School of Public Health, University of Wisconsin – Milwaukee
The escalating, contentious national discourse pitting the promotion of women’s health and well-being against claims by some of threats to religious liberty has its immediate origins in the work of the 2010-2011 The Institute of Medicine (IOM) Committee on Preventive Services for Women. As a member of the committee, I am pleased to share with you some of the background of this debate.
IOM is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely. The U.S. Department of Health and Human Services (HHS) requested that the IOM provide recommendations for implementing the Women’s Health Amendment (in Section 2713) of the ACA.
This part of the law requires that health insurance plans provide benefits, and prohibit the imposition of cost-sharing requirements, for prevention services. The compendium of preventive services to be covered with no additional out-of-pocket costs is to be based on clinical guidelines produced by the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices and the American Academy of Pediatrics (Bright Futures for Children). A comprehensive list of preventive services is available at www.healthcare.gov.
The ACA also requires that all private health plans cover a newly identified set of women’s preventive services with no cost sharing. Why focus on possible gaps for women? Women have longer life expectancies, a greater burden of chronic diseases and disability, reproductive and gender-specific conditions, and may have different treatment responses than men.
In Fall 2010, IOM assembled an expert committee to identify critical gaps in preventive services for women, as well as recommend measures that will further ensure women’s health and well-being. Over a six-month period, the Preventive Services for Women Committee distilled and deliberated the evidence and shaped a series of recommendations that were presented to HHS leaders in July 2012 in the report, Clinical Preventive Services for Women: Closing the Gaps. "The inclusion of evidence-based screenings, counseling and procedures that address women’s greater need for services over the course of a women’s lifetime may have a profound impact for individuals and the nation as a whole," stated the report.
The committee defined preventive health services as measures – including medications, procedures, devices, tests, education and counseling – shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition. The committee’s charge was limited to the study of girls and women age 10-65 years, and services in clinical settings.
The eight new preventive health services for women that the committee recommended be added to the services that health plans cover at no cost to patients under the ACA are:
- Screening for gestational diabetes
- Human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
- Counseling on sexually transmitted infections
- Counseling and screening for HIV
- Contraceptive methods and counseling to prevent unintended pregnancies
- Lactation counseling and equipment to promote breast-feeding
- Screening and counseling to detect and prevent interpersonal and domestic violence
- Yearly well-woman preventive care visits to obtain recommended preventive services
On Aug. 1, HHS accepted the committee recommendations in full and ruled that that new private health plans must cover the guidelines on women’s preventive services in play starting on or after Aug. 1, 2012. HHS also proposed an interim rule for religious exemption for certain group health plans. The question of individual and institutional religious ‘freedoms’ and the overarching legality of the ACA are being challenged, in the court of public opinion and the Supreme Court. Should the ACA prevail, including its additional preventive services for women, in a few months there will be a remarkable opportunity to ensure coverage of the fullest array of evidence-based services they may need for many more women in the United States. The establishment of covered ‘well-women visits,’ for women at every age and stage, can literally open doors to prevention services in unprecedented ways.
Beyond sharing an indefatigable optimism that science will prevail over ideology, I encourage my MCH colleagues to speak truth to power as champions of every woman’s health and well-being.
This information adapted from the IOM Clinical Preventive Services for Women: Closing the Gaps report website: www.iom.edu/Reports/2011/Clinical-Preventive-services-for-Women-Closing-the-Gaps.aspx