(CBS/AP) In a controversial move, the Obama administration said Monday that health insurance plans must cover birth control for women - and that's not all.
The decision is part of a broad expansion of coverage for women's preventive care under the Affordable Care Act.
"These historic guidelines are based on science and existing (medical) literature and will help ensure women get the preventive health benefits they need," said Health and Human Services Secretary Kathleen Sebelius.
The requirements take effect Jan. 1, 2013, in most cases. Tens of millions of women are expected to gain coverage, with that number likely to grow with time.
Sebelius acted after a near-unanimous recommendation last month from a panel of experts convened by the Institute of Medicine, which advises the government. Panel chairwoman Linda Rosenstock, dean of public health at UCLA, said prevention of unintended pregnancies was essential for women's psychological, emotional, and physical health.
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. Medicaid, the health care program for low-income people, also covers contraceptives.
More than 90 million prescriptions for contraceptives were dispensed in 2009, according the market analysis firm INS health. Generic versions of the pill are available for as little as $9 a month. Still, about half of all pregnancies are unplanned. Many are among women using some form of contraception, and forgetting to take the pill is a major reason.
Preventing unwanted pregnancies is only one goal of the new requirement. Contraception can help make a woman's next pregnancy healthier by spacing births far enough apart, generally 18 months to two years. Closely spaced births have been linked to prematurity, low birth weight, and autism. Research has shown that even modest copays for medical care can discourage use.
In a nod to social and religious conservatives, the rules issued Monday by Sebelius include a provision that would allow religious institutions to opt out of offering birth control coverage.
"It's a step in the right direction, but it's not enough," said Jeanne Monahan, a policy expert for the conservative Family Research Council. As it now stands, the conscience clause offers only a "fig leaf" of protection, she added, because it may not cover faith-based groups engaged in social action and other activities that do not involve worship.
Who's going to pay for all the free birth control? The cost will be spread among other people with health insurance, resulting in slightly higher premiums. That may be offset to some degree with savings from diseases prevented, or pregnancies that are planned to minimize any potential ill effects to the mother and baby.
The requirement applies to all forms of birth control approved by the FDA. That includes the pill, intrauterine devices, the so-called morning-after pill, and newer forms of long-acting implantable hormonal contraceptives that are becoming widely used in the rest of the industrialized world.