Closing The Gap
The California Legislature is set to pass the Contraceptive Equity Act. Women's rights advocates say it's about time.
Thursday, August 12, 1999
Today, according to statistics used by state Assemblymember Robert Hertzberg, (D-Sherman Oaks), 30 percent of the Health Maintenance Organizations (HMO''s) and half of traditional health care plans in California still fail to provide any contraception coverage whatsoever. That''s why American women''s out-of-pocket health care is 68 percent higher than men''s. Women''s rights advocates say that inequity is unacceptable, particularly in light of the fact that most health plans cover the men''s impotence drug Viagra.
In an effort to bridge the gap, the California Legislature may soon mandate contraception coverage. The Contraceptive Equity Act, introduced as AB 39 by Hertzberg in the state Assembly and SB 41 by Sen. Jackie Speier, (D-Hillsborough), in the state Senate, would require employers to carry health plans that cover the cost of contraception. Both bills have passed their respective houses and await a vote this month by the other house.
"This bill," says local American Civil Liberties Union (ACLU) attorney Michelle Welsh, "really goes a long way in closing the gender gap in health care."
The Contraceptive Equity Act, if passed by the state Legislature this month and signed by Gov. Gray Davis, would require California employers that provide health plans offering prescription drug benefits to cover contraceptives. Moreover, the bill would require those health plans to offer a wide range of contraceptive choices. Many health care plans that do currently cover contraception only offer women one or two choices. For instance, the Blue Cross of California Prudent Buyer plan offered to employees of the Weekly covers oral contraceptives and Depo-provera, but fails to cover contraceptive devices, such as IUD, Norplant, and diaphragms.
Offering a wide range of contraception is important, says Dr. Charles Beal, a family practitioner with the Monterey Preventive Medical Clinic, because not all women can tolerate hormonal contraception. "Women should have the full range of options," says Beal. "I think that''s extremely important."
The road to health care equity has been long and political. It took legislation to ensure that mammography for women over 50 and cervical cancer screenings were covered by insurance companies and employers. As far as efforts to legislating contraceptive coverage go, four previous bills have been introduced in the state Legislature in previous years: one died in Assembly committee, the other three were passed but vetoed by then-Gov. Pete Wilson.
This time around, things are different. There''s a Democratic governor now in Sacramento. And the insurance lobby has backed away from opposing the bill after a study prepared by Hertzberg and Speier showed that the average cost of contraception for a health plan is $16 per year per employee, whereas the average cost of intensive neonatal care is $2,000 a day.
Ironically, the coming of Viagra best fueled arguments in support of the Contraceptive Equity Act. As soon as it was approved by the Food and Drug Administration, Viagra was included in health plan formularies across the country, leaving women''s rights advocates in gape-mouthed disbelief. How could a man''s sexual performance, they wondered, be considered important by insurance companies, but the prevention of unintended pregnancies was not?
"The fact that so many insurance companies were quick to accept Viagra," says Paul Hefner, a spokesperson for Hertzberg, "certainly laid bare the notion that whenever new technology becomes available for men, the insurance companies are willing to put it on their formularies but are not doing the same for women."
The bill, cosponsored by the American College of Obstetricians and Gynecologists and California Planned Parenthood, sports a long list of supporters from an array of interest groups--the California Medical Association, the California Teachers Association, and Engineers and Scientists of California, to name a few.
Official opponents of the bill as it''s written number only four: California Association of Catholic Hospitals, the California Catholic Conference, the California Manufacturers Association and the Californians for Affordable Health Reform.
Opponents of the bill point to a July 5 study conducted by the accounting firm Pricewaterhouse Coopers as evidence that the need for mandated contraception coverage has been exaggerated by the bill''s authors. The confidential report made available to the Weekly contradicts the authors'' study, estimating that 90 percent of HMO''s, and 60 percent of Preferred Provider Organizations (PPO''s) and indemnity plans cover contraception.
Moreover, the Catholic lobby objects to the bill''s "conscience clause," saying it doesn''t go far enough to protect religious freedom. (However, Catholics for Free Choice and Catholics for Contraception support the bill.)
The bill includes a conscience clause that allows an exemption for religious employers opposed to birth control, but defines "religious employer" too narrowly in the view of the Catholic lobby in Sacramento. As currently written, the bill would exempt churches, synagogues, mosques, temples, missions, parochial schools, seminaries and convents from providing contraceptive coverage. But the California Association of Catholic Hospitals, says the association''s Legislative Advocate Bill Barnaby, would like to see the conscience clause expanded to include other religious employers, such as Catholic hospitals and charities. (Last year''s bill contained an expanded conscience clause, but was vetoed because it would have allowed women not covered for contraception due to the exemption to seek it through Medi-Cal.)
"The only amendment we seek is one limited to clearly bona fide religious entities with religious objection to contraception," says Barnaby. "We''re not trying to argue about the social need for contraception, that''s not an issue. What we''re looking for is an amendment that respects the religious concerns that some people have."
However, with an expanded conscience clause, argues Hefner, any number of organizations, such as the Reverend Sun Myung Moon''s chinchilla ranch in Southern California, could take advantage of the loophole.
"In our view of the world, there is a spectrum," says Hefner. "There is the priest or the nun whose work is the inculcation of religious belief and the performance of religious ritual, and at the other end of the spectrum is the nurse or orderly who works in the Catholic hospital. As you travel down that spectrum, the nurse or the orderly is more of an employee, and less of a religious employee.
"The bill doesn''t force contraception upon the most clearly religious enterprises," he continues. "It''s important to draw a bright line. If you''re working in a fairly secular enterprise, it''s important that the bill applies and that the religious beliefs of your employer doesn''t affect your health care."
"We really see this as strictly a fairness and equity issue," says Hefner. "Until we provide this coverage, an unequal and discriminatory form of health care continues to exist, and we think that''s dead wrong."