Health Overhaul May Bring Free Birth Control

Fifty years after the pill, another birth control revolution may be on the horizon: free contraception for women in the U.S., thanks to the new health care law.

That could start a shift toward more reliable — and expensive — forms of birth control that are gaining acceptance in other developed countries.

But first, look for a fight over social mores.

A panel of experts advising the government meets in November to begin considering what kind of preventive care for women should be covered at no cost to the patient, as required under President Barack Obama's overhaul.

Sen. Barbara Mikulski, D-Md., author of the women's health amendment, says the clear intent was to include family planning.

But is birth control preventive medicine?

Conflicting answers frame what could be the next clash over moral values and a health law that passed only after a difficult compromise restricting the use of public money for abortions.

For many medical and public health experts, there's no debate.

"There is clear and incontrovertible evidence that family planning saves lives and improves health," said obstetrician-gynecologist Dr. David Grimes, an international family planning expert who teaches medicine at the University of North Carolina. "Contraception rivals immunization in dollars saved for every dollar invested. Spacing out children allows for optimal pregnancies and optimal child rearing. Contraception is a prototype of preventive medicine."

But U.S. Catholic bishops say pregnancy is a healthy condition, not an illness. In comments filed with the Department of Health and Human Services, the bishops say they oppose any requirement to cover contraceptives or sterilization as preventive care.

"We don't consider it to be health care, but a lifestyle choice," said John Haas, president of the National Catholic Bioethics Center, a Philadelphia think tank whose work reflects church teachings. "We think there are other ways to avoid having children than by ingesting chemicals paid for by health insurance."

So far, most other religious conservatives have stayed out of the debate, though that could change. Some say they are concerned about any requirement that might include the morning-after pill. The Food and Drug Administration classifies it as birth control; some religious conservatives see it as an abortion drug.

Jeanne Monahan, a health policy expert at the conservative Family Research Council, said her group would oppose any mandate that lacks a conscience exemption for moral and religious reasons. She said there's "great suspicion" that a major abortion provider, Planned Parenthood, is leading the push for free birth control.

As recently as the 1990s, many health insurance plans didn't even cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans now cover prescription contraceptives. So does Medicaid, the health care program for low-income people.

The use of birth control is "virtually universal" in the U.S., according to a government report this summer from the National Center for Health Statistics. Nearly 93 million prescriptions for contraceptives were dispensed in 2009, according to IMS Health, a market analysis firm. Generic versions of the pill are available at Walmart stores, for example, for $9 a month.

Still, about half of all pregnancies are unplanned, and many occur among women using some form of contraception. The government says the problem is rarely the birth control method, but "inconsistent or incorrect use," such as forgetting to take a pill.

Advocates say free birth control would begin to address the problem.

"We can look at other countries where birth control is available for no cost, and what we see are lower pregnancy rates, lower abortion rates and lower teen pregnancy," said Cecile Richards, president of Planned Parenthood.

It would remove a cost barrier that may be keeping women away from more reliable long-acting birth control, and also affects those who don't do well on inexpensive generics.

A major research study now taking place in St. Louis provides a glimpse of how things might change.

The Contraceptive CHOICE Project is providing free birth control to as many as 10,000 women, tracking their decisions and the results. About 70 percent have chosen long-acting contraceptives such as IUDs (intrauterine devices) or implants, which are reversible and have a much lower failure rate than pills or condoms. The proportion of U.S. women using such methods remains low; part of the reason seems to be higher upfront cost.

"The shift we need to see in the United States is a shift away from methods like the pill and condoms to the most effective methods, like implants and IUDs," said Dr. Jeffrey Peipert, a principal investigator on the study. "And we'll only see that shift if somebody is willing to pay for it."

How the Obama administration will apply the law remains to be seen. It could allow insurance plans wide discretion on meeting the coverage requirement. A panel convened by the Institute of Medicine will hold its first meeting Nov. 16 to begin work on recommendations to HHS. The department has until next August to make its decision.

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Online:

Institute of Medicine: http://tinyurl.com/2fqa3yc

U.S. Conference of Catholic Bishops: http://www.nccbuscc.org/

U.S. government health care site: http://www.healthcare.gov/

National Catholic Bioethics Center: http://www.ncbcenter.org

Dr. David Grimes: http://davidagrimes.com/

Mikulski amendment: http://tinyurl.com/25ph2rn

Family Research Council: http://www.frc.org/

Planned Parenthood: http://www.plannedparenthood.org/

National Center for Health Statistics: http://www.cdc.gov/nchs/

Contraceptive CHOICE Project: http://www.choiceproject.wustl.edu/

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Text Messages, Radio Warn Haitians Of Cholera Risks

The cholera epidemic in Haiti is slowly spreading into new areas, mostly in the north of the country. The good news is that it doesn't seem to have taken hold in Port-au-Prince, the country’s densely populated capital.

As they track the disease's progress around the country, public health officials have launched a two-pronged education campaign using radio broadcasts and text messages to keep the epidemic out of the camps.

Education In The Camps

The Cahamega camp sprawls along a city street while trucks and cars rocket by on one side and planes land and take off on the other. The camp itself is a maze of tents, each separated by only a few feet.

It's as if you're walking through a field of giant mushrooms — a dirt lane serves as "main street," and people who live there set up tables to sell food, whiskey and socks. A woman sits in a chair getting her hair done.

Farther along, a truck is pumping water into a huge bladder that serves as the camp's water supply. It's 20 feet square and 6 feet high.

Several radio producers who work for the International Organization for Migration, a group affiliated with the United Nations, are visiting the camp. They file into a tiny, makeshift theater with tarps thrown over scaffolding, and a dozen benches of rough planks.

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Candidates Take Aim At Climate Bill To Win Votes

Two years ago, both the presidential candidates were big supporters of "cap-and-trade" legislation designed to fight climate change across the economy, but ads and debates in this election season show how unpopular that idea has become.

Democrats are running commercials declaring they're against it because it would raise energy prices and hurt their states' economies. And Republican ads attack Democrats for supporting the bill, which passed the House but stalled in the Senate.

None of those commercials is quite as memorable as one being aired by West Virginia Gov. Joe Manchin, who is running for Senate. The Democrat is so determined to show the people in his state that he's against the climate bill that in his ad he loads a rifle and points at a copy of the legislation.

"I'll take dead aim," Manchin says right before he pulls the trigger, "at the cap-and-trade bill, because it's bad for West Virginia."

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Fox News Poll: Most Dissatisfied With Washington

With less than a week to go before Election Day, widespread dissatisfaction with the way things are going in the country combined with negative views of the economy and frustration with the government point to major trouble for the incumbent majority Democrats. In addition, a Fox News poll released Friday shows President Obama?s job approval has hit a record low.

The new poll finds if the election were held today, 50 percent of likely voters would favor the Republican candidate in their House district and 37 percent the Democratic candidate, with 10 percent still undecided.

When it comes to enthusiasm, more Republicans (76 percent) than Democrats (65 percent) are extremely or very interested in the elections, and more Republicans (91 percent) than Democrats (83 percent) plan to vote for their party?s candidate.

Yet votes for the Democratic candidates look more solid: 87 percent say they will definitely vote for the Democrat, while 12 percent could change their mind. Among those favoring the Republican, 82 percent are definite they will vote that way and 16 percent may change their vote.
Among the 18 percent who have already voted, ballots have been evenly cast between the Republican and Democratic candidates.

The national telephone poll was conducted for Fox News by Opinion Dynamics Corp. among 1200 registered voters from October 26 to October 28. For the total sample, the poll has a margin of sampling error of plus or minus 3 percentage points. For the subgroup of 764 likely voters, the margin of sampling error is plus or minus 3.5 points.

The Obama Factor

Two-thirds of voters are dissatisfied with the way things are going in the country today, and more than not think Barack Obama?s presidency has made the country weaker (45 percent) rather than stronger (37 percent).

The president?s job approval among registered voters is currently 41 percent, a record low. This compares to 43 percent in mid-October and 46 percent in early September. Half disapprove of Obama?s performance. Among likely voters, negative sentiment is even stronger: 40 percent approve and 55 percent disapprove.

Frustrations are high. Most voters feel dissatisfied (51 percent) or even angry (25 percent) about the way the federal government is working. Just one in five is satisfied (22 percent), while 2 percent are enthusiastic. Angry voters are backing the Republican candidate by a 65-point margin.

Nearly half of likely voters -- 46 percent -- say they will cast their vote to express opposition to Obama administration policies. That shouldn?t be surprising given almost all voters rate economic conditions negatively, only a quarter thinks the stimulus plan has helped the economy, and fewer than one in five wants the new health care law to remain intact.

About a third of likely voters say they will use their vote to express support for Obama policies, and 20 percent say the president will not be a factor in their vote.

Forty-seven percent of likely voters approve of the job their own representative is doing. Even so, most -- 76 percent -- disapprove of the job Congress is doing overall.

Nearly equal numbers of voters have a positive view of the Democratic (42 percent) and Republican (44 percent) parties. By a six-point spread, more voters have a negative view of the Democratic Party.

Congressional Voting

Independents favor the Republican candidate in their district by 41 percent to 27 percent, with 32 percent saying they will vote for a third party candidate or are still undecided. This raises the question of whether these independents really will show up at the polls Tuesday.

Men back the Republican candidate by a wide 30 percentage point margin. Among women, the vote splits more evenly: 45 percent back the Democrat and 42 percent the Republican.

Eighty-seven percent of likely voters who support the Tea Party movement are backing the Republican candidate.

While 76 percent of those who backed Obama in 2008 are voting for the Democratic House candidate, some 13 percent are defecting to the Republican. More of Republican Presidential nominee John McCain?s voters -- 88 percent -- are sticking with the Republican this year.

Key Issues

The top issue to voters this election is the economy, followed by the trustworthiness of candidates, government spending, health care, and the federal deficit.

By a wide 60-34 percent, voters disapprove rather than approve of Obama?s handling of the economy. Fully 90 percent rate economic conditions negatively, and more than twice as many say they are worse off today compared with two years ago (36 percent) as say they are better off (16 percent).

A 55 percent majority of voters disapproves of the job Obama is doing on health care. In addition, many would like Congress to repeal the new health care law, either entirely (29 percent) or in part (29 percent). Others would like to see the law expanded (20 percent). The smallest group is the 15 percent who wants to leave the law as it currently is.

Of the issues tested, the president receives his highest approval rating for his handling of Afghanistan: 43 percent approve and 45 percent disapprove.

Click here to see the raw data.

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Study: Legalizing Pot In Calif. Won't Hurt Cartels

On Tuesday, California voters will decide whether to legalize marijuana in the state. Supporters of Proposition 19 say legalization will undercut the profits made by Mexican drug cartels and eliminate the need for violent crimes. But a recent study by the RAND Corp. finds the overall hit to the cartels could be minimal.

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Haunted House Has Painful Past As Asylum

A former institution for the mentally and physically disabled, located outside Philadelphia, is the site of a new Halloween attraction.

The sprawling Pennhurst State School and Hospital was shut down in 1987 after years of chronic overcrowding and patient abuse. Now a businessman has turned the property into a haunted house. The move has upset people who say it trivializes the suffering of those who lived there.

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