A half-century after the advent of the pill, the Obama administration on Monday ushered in a change in women's health care potentially as transformative: coverage of birth control as prevention, with no copays.

Services ranging from breast pumps for new mothers to counseling on domestic violence were also included in the broad expansion of women's preventive care under President Barack Obama's health care overhaul.

Since birth control is the most common drug prescribed to women, health plans should make sure it's readily available, said Health and Human Services Secretary Kathleen Sebelius. "Not doing it would be like not covering flu shots," she said.

Officials said the women's prevention package will be available Jan. 1, 2013, in most cases, resulting in a slight overall increase in premiums. Tens of millions of women are expected to benefit initially, a number that is likely to grow with time.

At first, some plans may be exempt due to an arcane provision of the health care law known as the "grandfather" clause. But those plans could face pressure from their members to include the new coverage.

Sebelius acted after a near-unanimous recommendation last month from a panel of experts at the prestigious Institute of Medicine, which advises the government. Panel chairwoman Linda Rosenstock, dean of public health at the University of California, Los Angeles, said that prevention of unintended pregnancies is essential for the psychological, emotional and physical health of women.

As recently as the 1990s, many health insurance plans didn't even cover birth control. Protests, court cases, and new state laws led to dramatic changes.

Today, almost all plans cover prescription contraceptives with varying copays. A government study last summer found that birth control use is virtually universal in the United States. Still, about half of all pregnancies are unplanned, many among women on some form of contraception who forget to take the drug. Preventing unwanted pregnancies is only one goal of the new requirement.

In a nod to social and religious conservatives, the rules issued yesterday by Sebelius include a provision that would allow religious institutions to opt out of offering birth control coverage. However, many conservatives, saying the conscience clause is insufficient, are supporting legislation by Rep. Jeff Fortenberry (R-Neb.) that would codify a range of exceptions to the new health care law on religious and conscience grounds.




BIRTH CONTROL. All forms approved by FDA including the pill, intrauterine devices, "morning-after" pill and newer forms of long-acting implantable hormonal contraceptives.

SCREENINGS. At least one annual "well-woman" preventive-care visit, screening for the virus that causes cervical cancer for women 30 and older, annual HIV counseling and screening, annual STD counseling, domestic violence counseling.

PREGNANCY SUPPORT. Prenatal screening for diabetes, support for breast-feeding mothers.

EXCEPTIONS. Copays may be charged for brands for which a generic is available.

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