Contraceptive parity: It's time for action
By Lisa Kaeser, JD
The Alan Guttmacher Institute
Washington, DC
Addressing a longstanding discrepancy in private insurance coverage, bills have been introduced in both houses of Congress that require insurers already covering general medical care and prescription drugs also to cover contraceptive services and prescription supplies. Along with funding for the Title X family planning program, the measures have become a central component of the reproductive health political agenda.
The Equity in Prescription Insurance and Contraceptive Coverage Act (EPICC) would ensure that employment-related insurance plans that cover outpatient medical services also cover contraceptive services, and private plans that cover prescription drugs cover prescription contraceptive drugs and devices. The legislation defines contraceptive services as "consultations, examinations, procedures, and medical services provided on an outpatient basis and related to the use of contraceptive methods (including natural family planning) to prevent an unintended pregnancy."
The Senate bill was introduced in May 1997 with bipartisan support by Sens. Olympia Snowe (R-ME) and Harry Reid (D-NV). It was quickly endorsed by many of the nation's leading health care organizations, including the American College of Obstetricians and Gynecologists in Washington, DC; the American Academy of Pediatrics in Elk Grove Village, IL; the American Academy of Family Physicians in Kansas City, MO; and the American Nurses Association in Washington, DC, as well as many women's groups. In July, a companion bill was introduced in the House by Reps. Jim Greenwood (R-PA), Nita Lowey (D-NY), and Henry Waxman (D-CA).
More than 30 senators and 70 House members have cosponsored the bills. It is improbable the bills will be taken up separately in this short legislative year, but their sponsors are looking for appropriate legislative vehicles to attach them to.
In a year noted for vitriolic debates about late-term abortions and "gag rules" imposed on international family planning providers, EPICC was a breath of fresh air for members on both sides of the issue. Arguing that the rates of unintended pregnancy and abortion must be reduced, Reid, who usually votes against abortion, said, "Providing access to contraception will bring down the unintended pregnancy rate, ensure good reproductive health care for women, and reduce the number of abortions. Prevention is the common ground on which we can all stand. Let's begin to attack the problem of unintended pregnancy at its root."
Many methods not covered
Currently, many private insurance companies - including half of traditional fee-for-service plans as well as some types of managed care plans - typically do not cover reversible contraceptive services. (Ironically, since many private plans cover surgery, both sterilization and abortion procedures are far more likely to be covered.)
A study by The Alan Guttmacher Institute in 1994 showed that even plans providing some coverage of prescription contraception often don't cover the major methods approved by the U.S. Food and Drug Administration (oral contraceptives, intrauterine devices, diaphragms, Norplant, and Depo-Provera).1 For example, although 97% of traditional plans cover prescription drugs in general, only 33% cover oral contraceptives. Conse quently, women of reproductive age spend 68% more in out-of-pocket costs than men do, with reproductive health costs accounting for the bulk of the difference. Many end up choosing less expensive methods, which in turn may be less effective or not as medically appropriate for them.
Several state legislatures have begun to recognize these disparities and are attempting to enact state-level remedies. In early April, Maryland approved legislation mandating contraceptive coverage, which made Maryland the first state to do so. The governor is expected to sign the bill. The measure allows religious organizations an exemption if contraceptive coverage would conflict with their "bona fide religious beliefs and practices."
In 1997, Virginia became the second state to enact a law requiring that insurance plans at least offer coverage to employers purchasing plans. (Coverage is not mandated.) Hawaii passed a similar measure in 1993. Also in 1997, for the second time in three years, California came close but failed to enact legislation that would mandate private insurance coverage of contraception. Gov. Pete Wilson, responding to opposition from the insurance indus try and small business groups, vetoed the first bill presented to him in 1995. Just a few months ago, he vetoed a revised bill that addressed most of his concerns. That time, however, he issued a veto message that explained that if he received a third measure that includes a "conscience clause" (allowing companies to refuse to cover contraception as a matter of conscience), he probably would sign it. Another bill is expected to be sent to the governor later this year.
Along with California, bills in Illinois, New York, and Massachusetts are still pending. Other states are expected to take action and keep this critical issue well afloat.
Reference
1. Alan Guttmacher Institute. Uneven and Unequal: Insurance Coverage and Reproductive Health Services. Washington, DC; 1994.
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