See all of our coverage of the IOM report and HHS guidelines here.

Will women’s health insurance be held hostage to the debt ceiling fiasco?

On July 19th, an expert panel convened by the Institutes of Medicine (IOM) released a set of evidence-based recommendations on the range of basic preventive care services for women that should be covered by insurance plans without a co-pay under health reform.  The recommendations were requested by the Department of Health and Human Services (HHS) to guide its final decision-making on these issues, and to put the imprimatur of peer-reviewed public health and medical science as well as evidence from clinical practice behind the final guidelines.

Services recommended by IOM for coverage without a co-pay include an annual well-woman visit as well as contraception, sterilization, gestational diabetes screenings, cervical cancer screenings, HIV/STI annual testing, domestic violence counseling, and breastfeeding support.  The Administration could have included these same services–including those on family planning services and contraceptive supplies–as part of its initial guidelines based on existing evidence. But the IOM process was seen by some as necessary not because these findings were not already self-evident to clinicians and public health experts, but because it is widely known that fanatical anti-choice groups and legislators would object to and fight against anything that improves the reproductive and sexual health of women or enables them to exercise their right to self-determination.

The problem always was that the IOM recommendations were scheduled to be delivered in late July 2011, and that HHS set a date of August 1, 2011 for issuing its final guildelines.  Those dates, we already knew, would fall squarely at the beginning of the 2012 Presidential campaign.  And, given that the Obama Administration has not exactly shown itself to be a strong voice on women’s health and rights when there is any political cost involved, delaying this decision until now has always been a political gamble.

Now that problem is compounded by the fact that the deadline also comes at the same time as the possible default of the United States on its debt for the first time in history.  Eschewing leadership from the beginning for a sickeningly-long process of “compromise” with Tea Party fanatics that was likely never possible nor going to be achieved, the White House finds itself at the brink of this disaster with no real solution.

Meanwhile, over the past week, the White House has twice “postponed” a conference call on the IOM guidelines with HHS Secretary Kathleen Sebelius and various other experts in and outside of the Administration. Now the tension appears to be rising among women’s health advocates: Press releases and calls on HHS to do the right thing for women based on evidence have been flooding my in-box and Monday 80 Democratic House members sent a letter to Sebelius calling on her to “adopt each of the recommendations in full.”

This may be business as usual and good advocacy strategy… gather your troops to make known your position and take nothing for granted.  Postponements of phone calls and silence from HHS may mean nothing at all.  Perhaps the White House has decided that adopting the recommendations in full next week will generate enough press on its own and that tamping down on other outreach during a politically-charged financial crisis is just smart politics, especially because the media keeps repeating the falsehood that this means “free” contraception.  That may be the case, but it further suggests that there is something controversial about contraceptive coverage; it “hides” rather than “changes the debate” on what should be a non-issue.  It strengthens rather than weakens the claims of fanatical anti-choicers over time because they exploit any and every weakness and we need a leader who is willing to stand up once and for all and silence this nonsense.

Or perhaps, feeling uneasy as I do, the letters, press releases and petitions suggest a growing anxiety that, having left this issue to be decided in the middle of a political season, one that has become even more fraught than perhaps anyone could have imagined, the recommendations on preventive care for women will be ditched or pushed off because the anti-science, anti-choice heat is just too much for this White House.  Perhaps it reflects lack of trust and fear that the Administration may not have our backs after all, even on contraception.

I hope that fear is not realized.