A half-century after the advent of the pill, the Obama administration Monday ushered in a change in women's health care potentially as transformative: coverage of birth control as prevention, with no co-pays.
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 Obama's health care overhaul.
The coverage requirement applies to all forms of birth control approved by the Food and Drug Administration, including 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.
Coverage with no co-pays for the morning-after pill is likely to become the most controversial part of the change. The FDA classifies Plan B and Ella as birth control, but some religious conservatives see the morning-after drugs as abortion drugs.
The rules issued Monday by the Department of Health and Human Services do not require coverage of RU-486 and other drugs that chemically induce an abortion.
Since birth control is the most common drug prescribed to women, health insurance plans should make sure it's readily available, said HHS Secretary Kathleen Sebelius.
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. 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.
Social and religious conservatives objected to the birth control mandate, saying a conscience exception unveiled by the administration is insufficient.
In a nod to conservatives, the rules issued Monday include a provision that would allow religious institutions to opt out of offering birth control coverage.
But many conservatives 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.
"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 all faith-based organizations.