States Consider Mandating Contraceptive Coverage


States are heeding the call of women's health advocates, who say coverage of contraceptives should be required if health insurance benefits cover prescriptions of the anti-impotence drug Viagra. Nine states -- California, Connecticut, Georgia, Hawaii, Maine, New Hampshire, Nevada, North Carolina and Vermont -- all enacted laws last year mandating contraceptive coverage, and the legislative trend continues this year.

Just last month, the Kentucky House passed a bill mandating that contraceptives be covered as prescription drugs. A similar bill has been approved by the Iowa Senate and a state House committee. Missouri's version of the legislation has gone through a House committee, and New York's contraceptive coverage bill has passed the Assembly and now awaits state Senate action.

According to the Alan Guttmacher Institute, a liberal-leaning think tank that tracks reproductive issues, 18 other states -- Alaska, Arizona, Delaware, Florida, Illinois, Iowa, Kansas, Massachusetts, Michigan, Mississippi, New Jersey, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Washington, Wisconsin --all had bills introduced this year or carried over from 1999 that require insurers to cover or offer to cover contraceptives. The Utah legislature considered a bill mandating contraceptive coverage in both 1999 and 2000. It failed both times.

Maryland's legislature was the first to enact a mandate for contraceptive coverage in 1998, the same year that Viagra, the popular drug antidote to male sexual dysfunction, hit the market. was unable to determine just how widely Viagra is covered, even though proponents of contraceptive coverage argue that because it is, common contraception methods should be covered as well.

Anti-abortion advocates, particularly the Catholic Church, oppose such bills.

"Our top priority in terms of healthcare is for the tens of millions who lack healthcare. Instead we see this drive to mandated benefits that many people don't want. We think that's a very twisted priority," said Richard Doerflinger, associate director at the Secretariat for Prolife Activities, National Conference of Catholic Bishops.

The Catholic Church is against all forms of birth control except natural family planning. In order to avoid offering a benefit that it is morally opposed to, the Church has lobbied for laws to include religious exemptions, or clauses that allow employers to opt out of offering contraceptive coverage if it conflicts with the employer's moral values.

Some of the recently enacted laws -- in California, Connecticut, Hawaii, Maine, Maryland, Nevada and North Carolina -- contain religious exemptions.

Proponents of contraceptive coverage, including women's health and reproductive rights advocates, say that women should enjoy benefits aiding pregnancy prevention if treatment of male sexual dysfunction is going to be covered. They also argue that covering women for contraceptives would probably cut costs in unwanted pregnancies and abortions.

"It's [birth control] a prescription. Why wouldn't it be covered? Why would it be different than any other medicine?" said Margie Kelly, spokesperson for the Center for Reproductive Law and Policy, a women's health advocacy group.

"The cost right now [of contraceptives for women] is a few hundred dollars per year out of pocket. That's an expense that a lot of women just can't bear. It [covering contraceptives] would end up costing less than having a pregnancy go to term," Kelly said.

Women of reproductive age, from 15 to 44, pay 68 percent more out of pocket for health care than men do, Kelly said. According to a 1998 report done by the Alan Guttmacher Institute, covering contraceptives as prescription drugs for women would cost employers about $1.43 per month, or an increase of less than 1% in providing medical coverage.

Cost is an issue for the Health Insurance Association of America, the powerful lobbying arm of the health insurance industry.

"We take no issue with the merit of any mandate. We oppose mandates across the board because collectively, they raise the cost of coverage and consequently raise the number of uninsured Americans," said Richard Coorsch, a HIAA spokesperson.

According to the Center for Reproductive Law and Policy, less than half, or 49 percent, of preferred provider organizations and fee-for-service insurance plans presently cover all five of the most common types of contraceptives, all approved by the federal Food and Drug Administration: birth control pills, diaphragms, IUDs, Norplant and Depro Provera.

While states have taken the lead on the issue, women's groups are also pressing for action in Congress. The Equity in Prescription Insurance and Contraceptive Coverage Act (EPICC), introduced in 1999 by Sens. Olympia Snowe (R-Maine) and Rep. James Greenwood (R-Pennsylvania) mirrors the bills passed by the states. It has yet to be considered by the Senate or the House.


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