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Government Watch

Should Your Plan Cover Contraceptives?

Today we kick off Government Watch, an occasional column devoted to updates on pending health legislation of interest to consumers.

January 19, 1998|SHARI ROAN

What: Equity in Prescription Insurance and Contraceptive Coverage Act of 1997 (EPICC) and AB 160.

At Issue: If your insurance plan covers antibiotics, hypertension medications and remedies to treat toenail fungus, should it also cover contraceptives?

Many health experts and government representatives say yes. And, after years of discussion and grass-roots campaigning, these two major pieces of legislation are now before federal (EPICC) and state (AB 160) lawmakers that would mandate insurance coverage of contraceptives.

When: Action expected this spring.

What's at Stake: The arguments for these bills are strong. About half of all large-group insurance plans do not routinely cover any contraceptive method, according to the New York-based Center for Reproductive Law and Policy. About one-third of these plans cover oral contraceptives. Only 18% pay for intrauterine devices and 24% cover Norplant. Even some of the companies providing insurance coverage to federal employees and military families withhold contraceptive coverage.

Unintended pregnancy, meanwhile, is a huge and embarrassing problem in the United States. About 1.6 million abortions and 1.5 million births from unintended pregnancies occur annually in the nation--one of the highest rates among Western countries. Research shows that access to contraception reduces the probability of having an abortion by 85%.

The contraceptive-coverage measures are considered cost-effective as well. A 1996 study concluded that every tax dollar spent for contraceptive services saves an average of $3 in Medicaid funds that would have been spent on prenatal and newborn care.

A similar bill passed the California Legislature in 1995 but was vetoed by Gov. Pete Wilson based on his concerns over the fiscal impact of the measure. Since then, research has been done showing that adding contraceptive coverage would cost businesses about $16 per employee each year. The bill would require insurance companies to add contraception to their prescription packages.

Prospects: In California, AB 160 was not supported recently in a government blue-ribbon commission on HMOs, which could ultimately hurt its chances for enactment. The bill, sponsored by Rep. Robert Hertzberg (D-Van Nuys), is awaiting a vote in the Assembly, where it is thought to have a good chance of passing.

On the federal front, EPICC has been introduced in both houses by sponsors Sen. Olympia Snowe (R-Maine) and Rep. James Greenwood (R-Pa.). The measure is thought to have broad support in the Senate and mixed appeal in the House. A hearing on the measure is expected to be held this spring.

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