DN Editorial: Government and science do mix

FOR ALL ITS FLAWS - and there were many - the Affordable Care Act took the first step toward a rational approach to health care. Beginning last fall, new health-insurance policies were required to drop co-pays or deductibles for "preventive services" like cancer screenings, immunizations and smoking-cessation programs.

It made all kinds of sense: Stopping health problems before they start means less pain and suffering - for people who don't get hepatitis or who don't develop heart disease or diabetes or who discover they have cancer in time to treat it. Besides, prevention is much cheaper.

But there was one big exception to the new policy: The law put off deciding whether prevention services are really prevention when preventing pregnancy.

Instead, the U.S. Department of Health and Human Services requested that the independent Institute of Medicine study medical data and take expert testimony before recommending whether to include contraception as a preventive service.

Last week the IOM said there should be no insurance co-pays or deductibles for any form of contraception that has been approved by the U.S. Food and Drug Administration. Also, insurance should cover other obvious prevention services like supporting breast feeding, testing for the human papilloma virus, and counseling for domestic violence.

We were stunned, but not by IOM's conclusions: By preventing pregnancy and abortion, birth control benefits the health and well-being of women and the children they already have. Even a relatively small co-pay for a woman with insurance (an average $14 per month for pills) can keep her from using contraception regularly or from using what might be a better, more expensive, method.

What struck us is just how unusual it has become to expect that a government decision might be based on scientific evidence, and only the evidence, rather than religious doctrine or political ideology.

Of course, the U.S. Conference of Catholic Bishops and socially conservative evangelicals want to keep that from happening. They maintain that the IOM recommendations, if accepted, would mandate that those who oppose because it violates their consciences would have to pay for insurance that provides them. Except insurance already provides the coverage and dropping co-pays would just make contraceptives more accessible.

(Besides, just what opponents of contraception are they talking about? A study by the Guttmacher Institute found that 98 percent of sexually active Catholic women and nearly 100 percent of sexually active evangelical women have used contraception at some point.)

As HHS Secretary Kathleen Sebelius said last week, the IOM report is "based on science." That should be the sole guiding principle in establishing health-care policy, and should make her decision, due next week, to adopt this recommendation an easy one.