Marcia Greenberger

WASHINGTON (WOMENSENEWS)–Twenty states require insurance companies that provide drug coverage to pay for contraceptives. Half require coverage for Pap smears. Only three states compel insurers to pay for screening for the symptomless sexually transmitted disease chlamydia.

Spotty insurance requirements such as these mean women across the country receive vastly disparate levels of medical treatment for some of their most common–and some of their most frightening–health care needs, according to a study released last week by the National Women’s Law Center and The Henry J. Kaiser Family Foundation.

The study, “Women’s Access to Health Care: A State-Level Analysis of Key Health Policies,” documents how geography can determine whether women have access to basic and critical medical care.

More than 63 million women–61 percent of those who are 18 to 64–are covered by job-related health insurance. Half of those policies are governed by state regulations. And those regulations carry wide implications: They can restrict access to abortions or emergency contraceptives; they can regulate how long women stay in hospitals following mastectomies and they can determine who is covered by Medicaid and what benefits they receive. They can, one of the study’s authors said, mean the difference between life and death.

The 17 percent of women under 65 who have no insurance face the gravest dangers. Uninsured women who are stricken with breast cancer have a far greater chance of dying–30 percent to 50 percent greater–than insured women, the study reported.

“We know that when you don’t have insurance, you put off getting care, and then you’re sicker, and then it’s more costly,” said Judy Waxman, vice president for health and reproductive rights for the National Women’s Law Center, a Washington-based advocacy group.

Advocates for women’s health said at a Washington press conference Wednesday that they hoped to use the report to pressure policymakers to broaden access to medical care for women, in every state, whether they are insured, uninsured or on Medicaid, the health care program for low-income people.

“It’s up to all of us, however we are situated, to shine the spotlight on the needs and the very practical solutions–and there are practical solutions . . . to deal with many of these issues,” said Marcia Greenberger, co-president of the National Women’s Law Center. “That’s perhaps the biggest crying shame about all of this: That there are practical solutions. It’s a question of will and priorities to just implement them.”

States Continue to Limit Access to Abortion

However, as states face growing budget shortfalls, advocates for women’s health care fear legislators will reduce coverage, particularly under Medicaid, a federal program run jointly with the states. The study found that the greatest activity in recent years has not been to increase access to health care services, but to limit access to abortion.

“The economic crisis raises real red flags about whether we’ll have to fight to keep the benefits we have, rather than expand them,” Greenberger said in an interview with Women’s eNews.

Every state except Utah has some requirement that insurance policies cover mammograms, according to the study. But only 25 states and the District of Columbia require coverage for Pap smears and other tests to detect cervical cancer; 14 mandate coverage for colorectal cancer screening and 11 for bone density tests to spot osteoporosis.

Perhaps the widest disparity in coverage involves reproductive health care, according to the study. Fewer than half the states require insurance policies to pay for all contraceptives approved by the U.S. Food and Drug Administration. At the same time, a majority of state legislatures have voted to place some restrictions on access to abortion. A full 43 states require parental consent or notification before minors may receive abortions. Forty states and the District of Columbia ban abortions once the fetus is considered viable. Thirty-one have so-called “partial-birth” abortion bans, which abortion opponents say refers to a specific late-term abortion method and abortion-rights advocates contend covers more common procedures. And, 22 states have mandatory waiting periods.

Only the state of Washington goes beyond federal law to provide additional protection to women targeted by protestors as they seek access to abortions or other reproductive health services.

Almost all states–45–allow health-care providers to refuse to perform abortions based on religious or moral objections and 24 allow them to refuse to provide family planning services.

Leslie Rottenberg, director of social services for Planned Parenthood of New York City, recalled one rape victim who was treated at a Catholic hospital that failed to provide her with emergency contraception–which can prevent pregnancy within days of unprotected sex–or to tell her she could receive it elsewhere. The woman later learned she was pregnant, Rottenberg said.

Contraceptive Coverage May Save Money

Lack of access to contraceptives can be dangerous and costly, the study’s authors said. Rottenberg said she knew a young woman who sought five abortions before Planned Parenthood workers helped her access birth control through Medicaid.

“It really doesn’t cost anything to add (contraceptive coverage) to a benefit plan,” Waxman added. “In fact, it may really even save money.”

Authors of the study reported some progress in the provision of emergency contraceptives–high-dose birth control pills or intrauterine devices that prevent fertilized eggs from implanting in the uterus. Slightly more than half the states cover emergency contraceptives for Medicaid recipients. Yet only seven states require hospital emergency rooms to offer them to sexual assault victims. And some conservative legislators are looking to prohibit state university health centers from providing emergency contraceptives to students, said Viola Baskerville, a member of the Virginia House of Delegates.

The outlook could be worst for Medicaid recipients, said Alina Salganicoff, director of women’s health policy for The Kaiser Family Foundation, a think tank and philanthropic organization based in Menlo Park, Calif. She said that many states, suffering shortfalls for the third straight year, are considering trimming Medicaid eligibility and benefits. A full 70 percent of adults who receive Medicaid are women, Salganicoff said.

Greenberger added that women must continue the battle for health care begun in the 1970s, when they won maternity benefits.

Expanded coverage for mammograms and other forms of health care have come about “in response to public demand,” she said. “It wasn’t by accident that that happened.”

Jodi Enda is a Washington-based reporter who formerly covered national news and politics, the White House and Congress for The Philadelphia Inquirer and Knight Ridder Newspapers.

For more information:

The Henry J. Kaiser Family Foundation:
“Women’s Access to Care: A State-Level Analysis of Key Health Policies”:

National Women’s Law Center: