QUESTION: When is preventive health care not preventive health care?

Answer: When the health care prevents unintended pregnancies - at least that's the position of the U.S. Conference of Catholic Bishops.

In a letter last week to the U.S. Department of Health and Human Services, the bishops argued that the new health-care-reform law should not consider birth control a "preventive service" to be provided without co-pays or deductibles.

This is not surprising: After all, the Catholic Church opposes artificial birth control on religious grounds.

What is astonishing is that, in 2010, there is any question that contraception qualifies as a preventive health service. But a decision on whether to include it in the health-care-reform guidelines - which, evident from the initial debates, was the intent of Congress when it passed health-care reform - has been put off for months.

Some background: While many benefits of the health-care-reform law won't take effect until 2014, some smaller changes to health insurance will provide big benefits in the next year. In particular, starting tomorrow, new health-insurance policies will be prohibited from requiring co-pays or deductibles for "preventive services" like cancer screenings, as well as immunizations and smoking-cessation programs. The idea is to cut health- care costs because prevention is much cheaper than treating illnesses.

In July, HHS published a list of the services that will be covered under this provision for public comment (which ended Friday). Not included: contraception. Instead, HHS asked the Institute of Medicine to make recommendations on what should be included beyond the current list. The deadline for those rules is next Aug. 1, well after the other services will be covered - and, maybe not coincidentally, after the midterm elections.

In the meantime, both sides are making their cases. The bishops - as well as some other conservatives - say that pregnancy isn't a disease and use of birth control is a "personal" or "lifestyle" choice. They also claim that some birth-control pills and other devices are a risk to health.

But science supports a different position. The Centers for Disease Control calls family planning one of the greatest health advances of the 20th century. Increased access to family-planning services has been an established public-health goal for decades.

Unintended pregnancies represent serious health risks for both women and their children. As HHS's own report "Healthy People" points out, many women who didn't want to be pregnant don't seek prenatal care in the first trimester, if at all. Women who didn't want a baby in the first place are more likely to use tobacco or alcohol during pregnancy. It follows that children who start out as unintended pregnancies are at greater risk of low birth weight, of dying in their first year, or of being abused.

If contraception isn't covered as a preventive service, even women with health insurance will be less likely to get it. Even small co-pays or modest deductibles can discourage people from seeking health care, especially preventive care. Co-pays for birth-control pills can be $40 to $50 a month, and the cost of more effective methods like IUDs and contraceptive implants are much higher.

Dozens of women's health organizations are urging HHS to streamline the process that the Institute of Medicine uses to make recommendations and the timing for insurance companies to comply; we agree.

In the case of birth control, the old saw that an ounce of prevention is worth a pound of cure couldn't be more relevant. Even more relevant: the separation of church and state. *