Sebelius Defends Birth Control Without Co-Pays

Aug 2, 2011
Originally published on August 2, 2011 10:16 am

The federal government recently announced that starting Aug. 2012, insurers must offer female preventive health services without extra costs to patients. Host Michel Martin discusses the controversial plan with the Health and Human Services Secretary. Martin also explores what the debt deal means for the Affordable Care Act with a Senior Correspondent from Kaiser Health News.

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MICHEL MARTIN, host: I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, while the Obama administration and members of Congress were struggling to come to an agreement to raise the debt ceiling, leaders of many states were keeping a close watch, too, because their credit ratings were about to be affected also. We will head to one of the states that was likely to be one of the most affected in the event of a default, South Carolina. That's coming up a little later in the program.

But first, while all this was going on, there was big news in the world of health care for women and families. Yesterday, the U.S. Department of Health and Human Services announced new guidelines that will require insurers to provide female preventive health services, including birth control, at no additional cost to patients.

Joining us now to talk about all this is the secretary for the U.S. Department of Health and Human Services, Kathleen Sebelius. Madam Secretary, thank you so much for joining us.

Secretary KATHLEEN SEBELIUS: Sure, Michel, great to be with you.

MARTIN: Obviously, we want to talk about the news that you announced yesterday. But we do need to ask you - as the leader of one of the country's largest and most visible departments in Washington; also, as a former governor who had to make some tough decisions about budgets in your time as well, we'd like to ask your perspective on the deal that was announced yesterday.

SEBELIUS: Well, I don't think there's any question that it is a huge relief for the American people to have Congress finally act on what was absolutely essential to raise the debt ceiling so that we can actually pay our bills. It's like a family not paying a mortgage. We've bought the house; we need to pay the bills.

I think this is a downpayment, as the president said, on moving ahead with our deficit issues and controlling future spending. I don't think there's any question that it's pretty one-sided at this point. And we are still missing the concept that he has described as an essential comprehensive element of this effort, which will be a shared sacrifice.

And raising revenue, particularly having the wealthiest Americans, the largest corporations in this country, contribute to getting our long-term financial house in order. And I'm hoping that this is step one, and that we will have an opportunity to really look at the long-term puzzle and, you know, a comprehensive strategy in the future. But...

MARTIN: Well, speaking of step one, now under step two, this super - bipartisan committee of 12 is supposed to identify spending cuts totaling $1.5 trillion. And it is said - it's being tounted, you know, that Medicare and Medicaid are walled off, but is that really possible?

SEBELIUS: Well, I think it is not only possible, I think it's important. Medicare - as you know, Michel - is part of the Affordable Care Act. A major step was taken in terms of getting the solvency of Medicare under control. And we were given a whole host of new tools to begin to align payment strategy for Medicare with what can be not only improved health outcomes but lower costs.

And that's going on in some of the best systems in the country. But prior to the passage of the Affordable Care Act, there was no real opportunity to retool the delivery system of health care. That's what we're going to accelerate, moving forward.

So beneficiaries will continue. Unlike the Republican proposal to end Medicare as we know it and essentially, break the commitment with beneficiaries, I think the president's committed to beneficiaries continuing to have the benefits in place.

But our directive is really to begin a very comprehensive overhaul of the delivery system, and re-engineer the system with the financial leverage of Medicare to actually get better results, better health, better patient outcomes at a lower cost. And again, that's not theoretical. It's going on in various parts of the country. It's just never been taken to scale.

MARTIN: All right. Well, let's talk about the news that you announced yesterday, this decision to require that women's preventive health services be covered under new insurance plans, including birth control. Why was this important?

SEBELIUS: Well, I think it's a very historic day for women in this country because, for the first time, the Affordable Care Act laid out a platform that required our department to develop a comprehensive set of prevention services that were particularly appropriate for women's health.

That has never been done before. And what we were directed to do is look at what was already in place with the Preventative Services Task Force and recommendations for the immunization committee, recommendations that were already in place for comprehensive guidelines from HRSA, but then fill in the gaps.

So we turned to the Institute of Medicine. This is a set of proposals developed by government workers or by politicians. It really - we went to scientists and doctors to say, where are the gaps in services around women's health? And they came back with a set of proposals, which include - you know - breast feeding and counseling strategies, include domestic-violence screening, include contraception for women, in a number of areas that...

MARTIN: Screening for the virus that causes cervical cancer, and for diabetes during pregnancy.

SEBELIUS: You bet.

MARTIN: Breast pumps for nursing mothers, an annual physical and so forth. So finally, Madam Secretary, I understand your time is limited and we appreciate it - your spending some of this time with us. As I understand it, the guidelines apply to new health plans beginning a year from now. How does that help all the women who are now covered by other policies where these matters are not covered, or will they still have to pay co-pays - which in some cases, are cost prohibitive?

SEBELIUS: The only co-pays that will be applicable, Michel, in the future is for the so-called grandfathered plans. And those are plans that essentially met guidelines under the Affordable Care Act as of March 2010 and don't, over the course of time, shift cost to their policyholders.

So, it's the - if you have a plan that you like and the employer doesn't shift huge costs onto employees or change the benefit package, those are not applicable. But having said that, we think most plan designs will begin to adopt a lot of these recommendations, and that this is very good news for the approximately 34 million women who are now looking at the possibility of having affordable contraception, available contraception without co-pays and deductibles. And that's a big step forward.

MARTIN: Kathleen Sebelius is the secretary for the U.S. Department of Health and Human Services. She was kind enough to join us on the phone from her office in Washington, D.C. Madam Secretary, we hope we'll speak again. Thank you so much for joining us.

SEBELIUS: Great to visit with you.

MARTIN: For additional perspective, joining us now is Mary Agnes Carey, a senior correspondent for Kaiser Health News. That's an independent news service. Mary Agnes, thank you so much for joining us once again.

MARY AGNES CAREY: Thanks for having me.

MARTIN: Let's just start where the secretary left off. Is this, in fact, a significant announcement, as we mentioned, that this regulation applies to new plans starting in January of 2013? So is it - or rather, 2012 - is this really a significant expansion of services for women?

CAREY: Oh, absolutely, because I think the plans had much greater variation. A lot of insurers cover some of these things. Some do, some don't. If you fit the criteria, you'll have to cover it when that plan comes up for renewal. So it's absolutely significant.

MARTIN: And let's talk about the debt ceiling and the effect on, you know, health care and the health care - sort of infrastructure. Health-care providers are none too pleased with the debt ceiling and deficit-reduction deal. And we're starting to hear from many of them.

You know, given that the proponents of it say that it protects Medicaid and Medicare - and even if this bipartisan commission recommends cuts, that the cuts to Medicaid and Medicare are limited to, supposedly, 2 percent - why are they so angry?

CAREY: What they're worried about is if you have across-the-board cuts. For example, let's say this panel can't report anything, and these across-the-board cuts kick in. Yes, it's 2 percent limited in Medicare, Medicaid and Social Security; you know, the low-income programs are off the table. But the providers - and here we're talking about like, hospitals or a home health agency - they're saying, wait a minute, you cut us by 2 percent; you're going to hurt the beneficiary.

You may say the beneficiary isn't impacted, but if you cut our revenues - and let's remember, a lot of these groups came to the table voluntarily during the debates over health-care reform and said, we will take less money in exchange for coverage, greater coverage of folks - so they're saying, wait a minute; you cut us now as part of this deal, it's going to further impact our ability to take care of patients. And that will hurt them and hurt, in particular, seniors' access to health care and Medicare. So that's where the rub is.

MARTIN: Are they saying that fewer doctors and health-care providers will be actually willing to provide service if this occurs? Is that what they're saying?

CAREY: Well, they haven't gone that far. And physicians have - there's been debate about whether physicians are going to drop Medicare beneficiaries if their payments were decreased. That's another whole facet of the law that's going to, you know - the policy, rather, that kicks in at the end of the year. But they definitely want to sound the warning to lawmakers: Be careful what you do - because their feeling is, it will impact the beneficiary.

MARTIN: Many Democrats have been adamant, saying that they would not support any reductions to Medicare as a part of this agreement. Yet half - in the House - half supported the agreement, which is - it couldn't have passed without them. Why did they, in the end?

CAREY: I think the fear of being blamed for a default on the debt was paramount, and they were scared to death of that - number one. Number two, they can look at this protection, if there's an across-the-board cut, and saying well, look, Medicare's protected by 2 percent - only hits the providers. Medicaid's off the table. Social Security's off the table.

MARTIN: They can argue that they've protected the most vulnerable people.

CAREY: Exactly. And that's been their argument all along. You know, the Republicans want to revolutionize Medicare and Medicaid. We don't. We're the protectors. They've run on this. That's going to be their theme all the way through 2012. And so they can - the message is consistent that way.

MARTIN: But you're still saying - and I hate to use this metaphor - but you're still saying it's going to be a bloody battle come this fall. It's going to be a very tough fight.

CAREY: It's going to be a very tough fight because this committee can look at entitlement reform. They can look at tax increases, but we've been talking about these areas for the last eight months on the Hill and there's no agreement. There'll be a lot of pressure on this committee to report something because Congress hates the idea of an automatic cut, that they're not controlling the power of the purse.

But - so you've got that shaping up; a Medicare physician payment fix expires at the end of December. Doctors will face something like a 29 percent cut of Medicare if they don't fix that. You have a lot of pressure; lawmakers looking for a lot of money where there isn't a lot of money.

MARTIN: And so there are a number of states that are still opposing the new health-care law. And in fact, one state, as we understand it, is not - is refusing to take any funds associated with it because their opposition runs that deep. So there's going to be a lot to cover. Hopefully, you'll come back and see us, and tell us more about this.

Mary Agnes Carey is a senior correspondent for Kaiser Health News. That's an independent news service. It is not affiliated with the health insurance company. And she was nice enough to join us once again in our studios in Washington, D.C. Mary Agnes, thank you so much.

CAREY: Thank you. Transcript provided by NPR, Copyright NPR.