States jump on the contraception bandwagon
Federal legislation lags behind states
Proposed changes in requiring private insurers to reimburse for contraception are making inroads into the statehouses before making their way to Capitol Hill.
In 1998, according to information published by the Alan Guttmacher Institute, a Washington, DC-based nonprofit reproductive health research group, 18 states introduced contraceptive coverage bills. And this past April, Maryland became the first state to require private-sector insurers to provide the same services advocated in a federal bill currently circulating in the halls of Congress.
Six states have laws
The Equity in Prescription Insurance and Contraceptive Coverage Act (EPICC) is designed to eliminate unequal health care cost burdens for women, as well as reduce the number of unintended pregnancies, pregnancy-related complications, and abortions in the United States.
Six states already have some legal requirement regarding contraceptive coverage: Virginia and Hawaii require contraceptive coverage to be offered to employers, while Montana, New Mex ico, Texas, and West Virginia require some insurance plans to cover contraception.
Supporters of the legislation, such as the Amer ican College of Obstetricians and Gynecol ogists (ACOG) in Washington, DC, argue that federal legislation is necessary to guarantee this protection for women who have health insurance under plans not regulated by individual states. Women covered by self-insured plans shielded from state regulation by the federal Employee Retirement Income Security Act (ERISA) and those who have individual health insurance are not protected by state laws.
EPICC would, in effect, amend ERISA and require all health plans to provide this service, says Richard Schwartz, MD, immediate past president of ACOG.
This shift in state and federal power may be the most powerful effect of such legislation, add both Maxwell J. Melman, JD, and Jay Wolfson. Melman is director of the Law Medicine Center at Case Western Reserve University in Cleve land, and Wolfson is professor of health law and finance at the University of South Florida in Tampa.
The only alternative to the "benefit of the month" approach currently taken by federal lawmakers would be to repeal ERISA, Melman says. That way, the states would have complete say over which benefits they want insurers in their state to provide. "They do that now, but self-insured plans are exempt under ERISA. The problem with that is, you get this state vs. federal debate."
"Insurance regulation has historically, by vir tue of the McCarran-Ferguson Act of 1945, been controlled exclusively by the states. There is no federal insurance law," says Wolfson. "This is a great departure from the traditional federal role regarding health insurance."
Congress previously has been unwilling to open up the ERISA protections for modification, he adds. "Once you start playing with ERISA, you open the floodgates to basically pulling down all the barriers that currently exist for consumers, providers, and insurance companies. Doing more flexible things that under ERISA are not currently allowed."
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