Texas state Rep. Senfronia Thompson

(WOMENSENEWS)–“No More Viagra-vation,” say the stickers that women’s health advocates in Texas are brandishing starting tomorrow, Sept. 1, when contraceptive equity becomes the law in President Bush’s home state.

Texas is the latest of 16 states to have passed laws requiring health benefits plans to cover contraception on the same level as other prescriptions. This year, Missouri and New Mexico have also enacted equity laws. New Mexico’s law went into effect in June and Missouri’s law will become effective on Jan. 1.

These laws bar health insurance plans from discriminating against women by making them pay personally for birth control pills, diaphragms and similar approved contraceptives if other prescription benefits are covered.

Texas state Rep. Senfronia Thompson, a Houston Democrat, pushed the bill through the legislature, arguing that it would bring an end to bedroom “redlining” and “covering his side of the bed and not hers.”

Texans used the disparity in the near-universal coverage for Viagra, the male erectile dysfunction pill released on the market in 1998, to make their point about discrimination and lack of coverage for women.

“The stars just aligned this year,” said Sarah Wheat, director of public affairs for Texas Abortion and Reproductive Rights Action League, explaining how the Texas legislature and Republican Gov. Rick Perry–known for their conservatism–approved the measure. “It felt good to do something preventative and positive.”

The contraceptive equity movement began in 1994, with Maryland passing the first law four years later. Twelve other states followed suit: California, Connecticut, Delaware, Georgia, Hawaii, Iowa, Maine, New Hampshire, Nevada, North Carolina, Rhode Island and Vermont. With the three newest states joining the roster, now 16 states have laws requiring contraceptive coverage. Another nine states have insurance regulations that support contraceptive coverage to some degree.

FDA-Approved Contraceptives Not Always Covered

The issue arises because most health insurance offers unequal and uneven coverage of contraceptive prescriptions, making patients pay for all or some of the five Food and Drug Administration-approved types: pills, including emergency contraception, diaphragms, implants such as Norplant, injections such as Depo Provera and Lunelle, and intrauterine devices, or IUDs.

Though nearly all plans cover other prescription drugs, a 2000 study of employers conducted by the Kaiser Family Foundation and the Health Research and Education Trust showed that, in every type of plan, coverage for birth control pills was offered significantly less often.

For example, researchers found that 60 percent of conventional plans covered birth control pills, but other drugs were covered by 87 percent; 62 percent of preferred provider organizations covered birth control pills but other drugs were covered by 98 percent; 87 percent of health maintenance organizations covered birth control pills, but other prescriptions were covered by 97 percent.

Out-of-pocket, birth control pills cost an average of $24 a month.

Map of states that have adopted contraceptive equity laws

Other methods of contraception were even less likely to be covered, according to data published by the Alan Guttmacher Institute in 1994. All five options were covered by only 15 percent of fee-for-service plans and by 39 percent of health maintenance organizations. New research will be undertaken this year.

“It’s a disproportionate burden on women,” said New York state Rep. Deborah Glick, sponsor of the Women’s Health and Wellness Act, a contraceptive equity measure in New York, where the legislature is still in session. “This is the one major preventative drug that the average adult woman needs, and for 20 to 30 years,” Glick said.

Despite successes, as many as 30 contraceptive equity proposals died in legislatures this year, said Karen Raschke, staff attorney for state programs for the Center for Reproductive Law and Policy. Among the states where bills failed were Alabama, Arizona, Florida, Illinois, Indiana, Louisiana, Minnesota, Montana, Nebraska, Oklahoma, Oregon and Utah.

In New York, Glick’s measure faces the active opposition of the Catholic Church, in a campaign that included a personal lobbying visit in March to the legislature by Cardinal Edward M. Egan of the Archdiocese of New York. Church representatives argue that religious institutions that oppose birth control should be exempt from providing coverage to employees, even if the employees want it or are not Catholic.

Lawmaker: Church Was Wrong on Galileo and It’s Wrong on Birth Control

“It’s untenable,” said Glick. “It’s 2001. They were wrong about Galileo and they are wrong about this.”

Of the states that already have contraceptive equity laws, four–Georgia, Iowa, New Hampshire and Vermont–have no exemption for religious organizations. Others provide exceptions, although some are defined narrowly.

The narrow exemption in the California law, passed in 1999, was the subject of a lawsuit by Catholic Charities of Sacramento. Religious organizations allowed to claim the exemption were limited to those with “inculcation of religious values” as their purpose, a definition which does not extend to religiously sponsored social service agencies. On July 2, 2001, a three-judge panel of the California Court of Appeals upheld the law, saying that Catholic Charities, a social services agency, might express its opinion about contraception to employees but is “required to provide benefits that do not discriminate against women.”

On Aug. 10, Catholic Charities asked the California Supreme Court to hear an appeal.

In another recent court action, insurers themselves became the targets for failing to provide small employers with plans that have full contraceptive coverage. Two class action lawsuits were filed in state court in Washington state on July 12 against Regence BlueShield, the state’s largest insurer. Suing as employers are two nonprofits, the American Civil Liberties Union and the Washington National Abortion and Reproductive Rights Action League (NARAL); individual employees are plaintiffs in the second action. Brought under state laws that provide protection from sex discrimination, the cases are being handled by Deborah Senn, who as the former insurance commissioner in Washington had sought to establish similar standards of contraceptive equity by incorporating them into the state’s insurance regulations.

Senn’s successor, Mike Kreidler, stopped implementation of the rules but on Aug. 22 held hearings on his own rule, to take effect in January 2002. The proposed wording, to be finalized in September, would require insurance companies to provide contraceptive coverage. Karen Cooper, executive director of Washington NARAL, expressed concern that the new proposal contains confusing language such as “medically necessary” contraception and exemptions for insurers who oppose contraception.

NEXT WEEK: Federal and labor union campaigns

Cynthia L. Cooper is a free-lance journalist in New York who specializes in reproductive rights issues.

Related Women’s Enews articles:

Pro-Choice Legislators Report Facing Constant Pressure (8/10/01):

Conscience Clauses Threaten Contraceptive Equity (3/23/01):

Most Catholic HMOs Deny Vital Women’s Services (10/31/00):

For more information:

“Contraceptive Equity Bills Gain Momentum in State Legislatures,” Center for Reproductive Law and Policy:

Cover My Pills campaign:

National Women’s Law Center, Pill4Us campaign:

Alan Guttmacher Institute:

National Abortion and Reproductive Rights Action League: