During the presidential campaign, Barack Obama said he would "work to reduce unintended pregnancy by guaranteeing equity in contraceptive coverage, providing sex education and offering rape victims accurate information about emergency contraception."
An announcement on Aug. 1, 2011, represented a landmark advance for this promise.
The Department of Health and Human Services announced new guidelines that would allow women to receive preventive health services at no additional cost. "Developed by the independent Institute of Medicine, the new guidelines require new health insurance plans to cover women"s preventive services such as well-woman visits, breastfeeding support, domestic violence screening and contraception without charging a co-payment, co-insurance or a deductible," the department announced.
The guidelines are scheduled take effect for plan years beginning on or after Aug. 1, 2012.
The announcement "has a similar effect to 'guaranteeing equity in contraceptive coverage" but goes even farther because in addition to saying plans must cover contraception, it also means they must do so without cost-sharing for the consumer," said Andrea Kane, senior director for policy at the National Campaign to Prevent Teen and Unplanned Pregnancy, an advocacy group.
Because of the controversial nature of reproductive health policy, the department also released "an amendment to the prevention regulation that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services."
Separately, the administration has pushed for funding for teen pregnancy prevention programs that fall under the category of "evidence-based" -- a clear shot at the preference during the prior administration for abstinence-based models. Indeed, the budget eliminated $95 million in funding for Community-Based Abstinence Education and $50 million for mandatory Title V abstinence education grants to states.
Congress approved the administration"s request for $110 million in funding for evidence-based teen pregnancy prevention programs for fiscal year 2010. It was reduced by $5 million in fiscal year 2011 in the agreement on the continuing resolution, but the grant program remained largely intact, Kane said.
The funding supports a competitive grant program under the Department of Health and Human Services' Administration for Children and Families, largely intended to fund "grants for programs to replicate curriculum-based models that have been shown through strong evaluation ... to be effective in reducing teen pregnancy, delaying sexual activity, or improving contraception use" without increasing sexual activity. Other portions of program are "used to fund grants for demonstration programs to develop, replicate, refine and test additional models and innovative strategies for preventing teen pregnancy."
According to the National Campaign, more than 1,000 organizations submitted applications, and 100 received grants.
One initiative -- to expand Title X, a program that offers family planning services, including counseling and contraception -- fared less well in the budget wars. The fiscal year 2010 appropriations bill included a $10 million increase for Title X, and the president proposed an additional $10 million increase for fiscal year 2011. However, the program ended up getting cut by $17 million after House Republicans had proposed eliminating it entirely.
Meanwhile, the administration has fully implemented language that would let states opt to expand eligibility for Medicaid family planning services to low-income individuals who do not qualify under current rules
Finally, on the issue of "offering rape victims accurate information about emergency contraception," HHS issued a final rule on federal health care conscience protections -- protections that allowed health care providers to opt out of participating in medical procedures that violate their moral and religious beliefs.
A rule issued during George W. Bush"s administration had caused controversy because some suggested that it effectively expanded the scope of the provider conscience statutes beyond abortion to contraception.
By contrast, the new rule says that "provision of contraceptive services has never been defined as abortion in federal statute. There is no indication that the federal health care provider conscience statutes intended that the term 'abortion" included contraception. The Department rescinds the definitions contained in the 2008 Final Rule because of concerns that they may have caused confusion regarding the scope of the federal health care provider conscience protection statutes."
The political sensitivity of each of the elements of this promise make them susceptible to changes in the future, including outright reversal. However, for now, they represent a fulfillment of Obama"s promise. We rate it a Promise Kept.