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The Invisible Mandate

On August 1, 2012, while most of the world was tuned into the Summer Olympics underway in London, American women experienced a milestone—and they didn’t seem to notice.

Thanks to Facebook’s Timeline feature, I am able to recall that morning clearly: driving into the hospital shortly after 4 a.m. to pre-round on my gynecologic oncology patients, NPR was busy reporting on the scandal that shook competitive badminton. Yet, despite coverage by major media both in print and on camera, I went home that evening without having heard a single mention of the groundbreaking changes to women’s preventive health coverage, which took effect that very day as stipulated by the Affordable Care Act.

In fact, now almost two months out, discussion on the practical implications of this shift in benefits is still conspicuously absent from the combined general OB/GYN and family practice clinics I regularly attend. Even the patients, who typically display a special talent for highlighting gaps in my knowledge of current events, have been uncharacteristically silent on the matter. So, and I don’t mean this rhetorically—why the silence?

Granted, many health plans have not yet met the stipulation of being newly created or renewed since August 1, but a large chunk of almost 47 million insured women should be receiving expanded coverage by this time next year, many of them in the next few months as plans often renew near the beginning of the year.

The law in question ensures, with one major caveat, free coverage for eight basic preventive services to women on any health insurance plan, including Medicare and Medicaid. Of note, a temporary exemption has been granted to employer health plans of certain religiously-affiliated organizations that have chosen to oppose the politically-charged provision for contraception, limited to that provision only and currently carrying a one-year expiration date. However, all nonexempt plans must provide the following eight services without cost-sharing: annual well-woman visits; screening for gestational diabetes; breastfeeding supplies and counseling; screening and counseling for interpersonal and domestic violence; screening and counseling for HIV; STI counseling; HPV DNA testing for women over 30; and last but certainly not least, coverage of all FDA-approved methods of contraception, including sterilization.

I hope my recent experience represents an exception rather than the rule, and I know I am not the only one who believes the events of August 1 to be notable—monumental, even. However, I suspect that for many physicians and patients alike, this news was received warily and tucked quietly away as we await the results of ongoing court battles and potentially game-changing elections. Let’s just not allow this story to end with complacency.

Nikki Nametz Nikki Nametz (2 Posts)

Editor Emeritus: Former Medical Student Editor (2012-2013) and Former Resident Editor (2013-2014)

University of Arizona College of Medicine

After completing medical school at University of Arizona College of Medicine in 2013, I've moved on to residency in obstetrics and gynecology at Kaiser Permanente -- Los Angeles Medical Center. I'm passionate about preserving women's reproductive choices, ensuring access to health care for all Americans, and facilitating scientific discovery in medicine. Also, I hate writing, which is unfortunate because I've got some things to say. (If this whole being a doctor thing falls through, I plan to camp outside The Onion headquarters until someone hires me.)