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Not just birth control — free sterilization, too

All student health care plans covering female college students in the United States must include coverage for free voluntary sterilization surgery, the Department of Health and Human Services announced late Friday afternoon.

Women of college age who do not attend school will also get free sterilization coverage whether they are insured through an employer, their parents, or some form of government-subsidized plan.

All student health plans, HHS said Friday as it finalized a new regulation under the Affordable Care Act (otherwise known as Obamacare) must cover the full set of cost-free women’s “preventive services” that HHS ordered last month must be covered by all U.S. health care plans.

These free “preventive services” include surgical sterilization procedures and all Food and Drug Administration-approved contraceptives, including those that cause abortions.

“These preventive health services include, with respect to women, preventive care and screening provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) that were issued on August 1, 2011,” HHS said in a request for comments about how the new regulation will be implemented.

“As relevant here, the HRSA Guidelines require coverage, without cost sharing, for ‘[a]ll Food and Drug Administration [(FDA)] approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity,’ as prescribed by a provider,” said the HHS description of the regulation, which will be published in the March 21 edition of the Federal Register.

In announcing the rule for college-based health plans, HHS said it would follow the same system for enforcing the rule on religious colleges and universities that object to purchasing sterilizations, contraceptives and abortifacients for its students that President Barack Obama has proposed for enforcing the regulation on religious non-profit organizations in the coverage for their employees: The insurer will be forced to provide the sterilizations, contraceptives and abortifacients to the students free of charge.

“Under the final rule, students will gain the same consumer protections other people with individual market insurance have, like a prohibition on lifetime limits and coverage of preventive services without cost sharing,” HHS said in a press release. “In the same way that religious colleges and universities will not have to pay, arrange or refer for contraceptive coverage for their employees, they will not have to do so for their students who will get such coverage directly and separately from their insurer.”

The U.S. Catholic Bishops have said that this mechanism does not satisfy their concerns about the regulation’s violation of the freedom of conscience and religion of those who have moral and religious objections to sterilization, artificial contraception and abortion. Institutions that object on moral and religious grounds would still have to provide insurance plans that covered these things, even if these particular services were theoretically paid for by the insurer rather than the institution securing the insurers services to cover its students and employees.

Also, just as the regulation requiring free coverage for sterilizations, contraceptives and abortifacients makes no accommodation at all for private-sector employers who object on religious or moral grounds, the rule requiring this coverage for students makes no accommodation for non-religious private schools that object on religious and moral grounds or for state colleges in states where local voters, taxpayers, legislators and governors may object to providing free sterilizations, contraceptives and abortifacients to college students.

The regulation in question was recommended by the Institute of Medicine, a government funded element of the National Academy of Sciences that HHS hired last year to come up with recommendations for “preventive services” to be mandated under Obamacare.

“The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity,” the IOM said in its report on the matter issued last July.

HHS adopted verbatim the recommendation of the IOM committee it hired to develop the recommendation.

The committee said women of “reproductive capacity” included those as young as 15 years of age.

“A wide array of safe and highly effective FDA-approved methods of contraception is available, including barrier methods, hormonal methods, emergency contraception, and implanted devices; sterilization is also available for women and for men,” the IOM said in explaining its mandate recommendation.

“This range of methods provides options for women depending upon their life stage, sexual practices, and health status,” said the IOM report. “Some methods, such as condoms, spermicides, and emergency contraceptives, are available without a prescription, whereas the more effective hormonal and long-acting reversible methods, such as oral contraceptives and intrauterine devices, are available by prescription or require insertion by a medical professional.

“Sterilization,” the IOM report said, “is a surgical procedure.”

In explaining the prevalence of contraception and sterilization in the United States, the IOM’s report on its recommendations cited a government study entitled, “The Use of Contraception in the United States: 1982 to 2008,” that was published by HHS’s Centers for Disease Control and Prevention in 2010.

The study said that 16.7 percent of American women between the ages of 15 and 44 have been sterilized. This includes 4.5 percent of American women ages 15 to 44 who have never been married.

Although surgical sterilization is less common among college-age women than older women, it does occur—even in the pre-Obamacare era when the federal government did not guarantee college-age women they could be sterilized for free.

According to this CDC report, among women ages 20-24, who are using contraception, 2.4 percent have been sterilized. Among those aged 25-29, who are using contraception, 15.0 percent have been sterilized.

The IOM report that HHS relied on in developing its mandate noted that the “most cost-effective” methods of contraception “were longer-acting contraceptives that do not rely on user compliance.” However, one problem the committee noted with these methods is that they have “high up-front costs.”

By requiring employers, colleges and insurers to fully subsidize the cost of these “preventive services,” the new HHS mandate effectively gets rid of the “high up-front costs” for devices and drugs implanted in women to render them infertile over long periods of time as wells as for sterilization surgery that can make them permanently infertile.

“In a study of the cost-effectiveness of specific contraceptive methods, all contraceptive methods were found to be more cost-effective than no method, and the most cost-effective methods were long-acting contraceptives that do not rely on user compliance,” said the IOM report on its mandate recommendations.

“The most common contraceptive methods used in the United States are the oral contraceptive pill and female sterilization,” said the report. “It is thought that greater use of long-acting, reversible contraceptive methods—including intrauterine devices and contraceptive implants that require less action by the woman and therefore have lower use failure rates—might help further reduce unintended pregnancy rates. Cost barriers to use of the most effective contraceptive methods are important because long-acting, reversible contraceptive methods and sterilization have high up-front costs.”

Appearing before the House Energy and Commerce Committee earlier this month, HHS Secretary Kathleen Sebelius argued that forcing the insurers covering employees of religious institutions that object to the mandate to provide sterilizations and contraceptives for free would save money because the number of human beings born would decrease.

“The reduction in the number of pregnancies compensates for the cost of contraception,” she said.

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