By Melinda Voss
WEnews Contributing Editor
Monday, June 26, 2000
The New York State Senate recessed without passing a bill that would have mandated insurance coverage for contraceptives, mammograms, bone density scans and pap smears. It mandated coverage for prostate screening but said women's health needs more study.
In the waning hours of its final session, the Republican-controlled New York State Senate dropped a far-reaching women's health and wellness bill, announcing instead the formation of a task force to study women's health and then swiftly passing a bill to mandate insurance coverage of men's prostate screenings.
Women's health care advocates expressed outrage and disappointment, saying that extensive studies already had identified women's health needs.
"This is insulting. The Senate Republican leaders seem to be saying that men's body parts are a higher priority than women's," said JoAnn Smith, executive director of Family Planning Advocates.
The Women's Health and Wellness Bill would have mandated insurance coverage for prescription contraceptives and devices, mammograms for women over 40, tests for cervical cancer and prevention and treatment for osteoporosis. The bill was passed overwhelmingly by the New York Assembly last January.
Twelve other states, including California, already have passed laws mandating insurance coverage for a range of contraceptives and services. Similar legislation on the federal level appears stalled.
"This would have set a great example for other states," said Lynn Grefe, national director of the Republican Pro-Choice Coalition. "Viagra was on the market for three months and it was covered. Contraceptives have been around for 40 years and they are still not covered."
A lot of women can't afford a bone density scan to test for osteoporosis, Grefe said. "But a scan and a prescription to prevent osteoporosis are a lot cheaper than a hip replacement. Let's not be short-sighted. This is sensible legislation."
Late Thursday the Senate announced that a task force was preferable to immediate passage of the bill for basic women's health. Early Friday morning, without study, the Senate swiftly mandated additional health insurance coverage for prostate screening and treatment.
In difficult, closed-door negotiations, some senators wanted to grant numerous exemptions which they call "conscience clauses" to many organizations which describe themselves as religious. Some also sought to limit contraceptive coverage to women 18 to 45 and to add provisions for men's health care.
The proposed New York legislation, backed by extensive medical studies, addressed what many women’s health advocates argue is a basic health care right.
The average U.S. woman spends about three-quarters of her reproductive life trying to avoid pregnancies, according to the Henry J. Kaiser Family Foundation, a research and communications philanthropy based in Menlo Park, Calif. About half of the 6.3 million pregnancies each year are unintended, Kaiser reported.
Costs for contraceptive drugs and devices typically range from $300 to $700 a year. Various studies show that from 20 percent to 61 percent of American women lack insurance coverage for contraceptives, depending on the type of insurance and their choice of contraceptives.
But Richard Coorsh, a spokesman for the Health Insurance Association of America, a group of insurers that covers 123 million people, said mandating coverage is not the answer.
“We take no issue with the merits of any mandate,” he said. “It’s like adding extra features to a new car. Invariably, these costs are passed on, and, in many cases, it’s small businesses that have to pay the lion’s share of the costs of mandates. These are the very businesses that can least afford them.”
In states that do not require insurance coverage, employers can decline to offer contraceptive coverage, and many do because they wish to save money.
Insurance coverage for the full range of prescription contraceptives is minimal. A recent estimate showed an employer’s cost to be as little as $1.43 per employee per month.
Twelve states have enacted contraceptive coverage measures since 1998, according to the Alan Guttmacher Institute, an advocacy group for reproductive services.
The other states are Maryland, Georgia, Vermont, Maine, Nevada, Connecticut, North Carolina, Hawaii, New Hampshire and California. A few other states have laws supporting more limited coverage.
The new comprehensive laws generally require insurers who cover prescription drugs to pay for contraceptive pharmaceuticals and services, such as inserting or removing devices. Most laws also include consumer protection provisions. Some cover only oral contraceptives, but not intra-uterine devices.
Some new laws also include provisions that allow religious organizations to exclude coverage for contraception from their benefits package if it violates a religious belief.
A recent World Health Organization study of health care in 191 countries indicated that the United States spends more than any other country on health care, $3,700 per person. However, the study ranked the U.S. 72nd in health care efficiency.
On the federal level, equity coverage has been slower. Congress voted to provide contraceptive coverage for all participants in the Federal Employees Health Benefit Program -- an important step because federal laws often influence coverage decisions by private insurers. But passage of a federal law ensuring contraceptive coverage for privately insured Americans appears stalled. A major push is expected next year.
The Equity in Prescription Insurance and Contraceptive Coverage Act was introduced in 1997 and 1999 by Senators Olympia J. Snowe (R-Maine) and Harry Reid (D-Nevada) and Representatives Jim Greenwood (R-Penn.) and Nita M. Lowey (D-N.Y.).
The bill prohibits health insurance plans that provide prescription drugs, devices and outpatient services from excluding benefits for FDA-approved prescription contraceptive drugs and devices (such as oral contraceptives, diaphragms, Norplant, Depo Provera, cervical caps, and Intra-uterine devises) and related outpatient services. The bill has considerable support, 137 co-sponsors in the House and 39 in the Senate.
Medicaid, which provides health coverage for low-income Americans, covers basic contraceptive care.
Polls show most Americans support requiring insurers to provide contraceptives as part of prescription coverage, even if premiums rise.
A 1998 study by the Kaiser Foundation showed health maintenance organizations were more likely to pay for contraceptives than conventional fee-for-service insurers or preferred provider organizations.
|Percent of Employees Who Receive Coverage for Contraception|
| ||Reversible contraceptives, such as Norplant||Oral contraceptives|
|Preferred Provider Organizations (PPOs)||44%||64%|
Melinda Voss has a master's degree in public health. A former reporter for the Des Moines register, she freelances and teaches journalism at the University of Minnesota.