Updated, 4:15pm EST, 12/3/09
By a vote of 61-39, the Senate passed the Mikulski Amendment to the Patient Protection and Affordable Care Act today. The Mikulsi Amendment, submitted by Sen. Barbara Mikulski (D-MD), requires all health plans to cover comprehensive women’s preventive care and related screenings, at no additional charge to women. Meaning, basic women’s health care like pelvic exams, mammograms, counseling, testing and treatment for sexually transmitted infections (STIs) and family planning will be available under all insurance plans with limited or no co-pays.
While the question on everyone’s mind is whether or not birth control falls under this list, it seems at the moment there is no clear answer. While contraception is not specifically listed in the amendment, Tait Sye, spokesperson for Planned Parenthood Federation of America tells me,
"It allows Health Resources and Services Administration (HRSA) [editor’s note: the Health and Human Services department developing these guidelines] to recommend what should be covered, so HRSA can/could recommend birth control be covered."
According to a Senate Democratic aide, responding to concerns that birth control is not specifically called-out in the amendment, if individual drugs or "even categories of drugs" were listed, "we would have seen amendments filed on each one (or each category). I trust Sebelius [Kathleen Sebelius, head of HHS] to do the right thing with respect to covering birth control."
Marcia Greenburger, co-President of the National Women’s Law Center is quick to note the impact this will have on low-to-middle income women who opt-out of basic care because of the added costs, even with insurance:
"We are pleased that the first amendment to the Senate’s health care bill will make preventative health care more accessible and affordable for millions of women – some of whom have limited health screenings, not by choice, buy by financial necessity."
The Amendment directs HRSA, under the Department of Health and Human Services (HHS), to set guidelines for exactly which women’s health services would be exempt from co-pays – a sticky issue for Republican senator Lisa Murkowski, from Alaska, whose "alternative" to the Mikulski Amendment is also being voted on today.
Murkowki’s women’s health amendment would allow private insurers to set these same guidelines, deciding which preventive services for women will or won’t be exempt from co-pays. But this is obviously problematic because, as Suzy Khimm writes at The New Republic, "as a for-profit industry, insurers naturally have the incentive to
offer less generous benefit packages that would require customers to
shoulder more out-of-pockets expenses like co-pays."
Women’s health care advocates are naturally thrilled at passage of the Mikulski amendment. Planned Parenthood Federation of America‘s Cecile Richards notes that preventive health care is "life-saving care" and the disparities between what men and women have historically paid for health care costs is huge:
"Women of childbearing age spend 68 percent more in out-of-pocket health care costs than men, in part because of reproductivce health-related needs. It is time that women’s health is made a priority, and providing affordable access to essential care is key…"
She is, of course, right. The "I am Not a Pre-Existing Condition" campaign started by the National Women’s Law Center and taken up by many women’s health and rights advocates, began because of these tremendous disparities and the bias that exists in insurance coverage: lack of coverage of maternity care (including prenatal care and childbirth), exorbitant costs related to childbirth even if covered under one’s insurance plan, the classification of c-sections and miscarriages as "pre-existing conditions" and subsequent denial of coverage for them, and lack of coverage of birth control are just some of the basic health services women have had to pay for out-of-pocket or go without.
Physicians are speaking out as well. Douglas Laube, MD, a board member with Physicians for Reproductive Choice and Health, applauds the decision:
"As a physician, I know that preventive care saves lives. Too many women die each year from cancers that could have been detected during an annual well-woman exam."
There are concerns, however, that allowing a government agency to decide these guidelines puts these decisions at the whim of the ideology of a different administration. "I know that there’s legitimate concern as to whether this bill gives such broad
discretion to the Secretary of HHS that under a different administration, we
could be in trouble when it comes to covering birth control, " the Senate aide tells me. "One note on that
— the bill gives the Secretary of HHS authority to define essential health
benefits, which must include the ten general categories of care listed on pg.
103 of the bill."
There are clear parameters for what must be considered, she says.
"In defining the essential health benefits, the Secretary must take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups."
The Mikulski Amendment, however, does not address abortion coverage. By now, regular readers of RH Reality Check know about The Stupak-Pitts Amendment passed in the House health care reform bill, severely restricting private insurance coverage of abortion. Senator Ben Nelson (D-NE) has been working to craft a similar amendment for the Senate health bill, though according to Lindsay Beyerstein, it is unlikely he’s got the votes to get it passed.
Still, as Beyerstein notes, the fight to ensure that health care reform remains "abortion neutral" is long from over. Once the Senate and House put their two bills together, the struggle to pull the U.S. Conference of Catholic Bishops (via anti-choice Democrats and Republicans) anti-choice stamp off of the bill will be difficult.
For now, women in the United States can claim a victory for our health care. Senator Mikulski has succeeded in leveling the playing field for women with private insurance coverage, ensuring that more women in this country are able to access preventive care, getting the health services they need and deserve.
Watch Mikulski in action here: