THE IRONY IS rich: Massachusetts, a state known for its health care and medical research — the state where Worcester-area scientists invented the birth-control pill — has lagged behind the nation when it comes to insurance coverage of contraception. Last year, when Rhode Island approved legislation requiring health-insurance plans to pay for prescription contraceptives, Massachusetts became the only state in New England without such a requirement.

Outside New England, 10 states have laws mandating that private insurers and employers cover contraceptives as they do any other prescription drug, according to the New York– and Washington, DC–based Alan Guttmacher Institute. The federal government already offers contraception benefits to its employees, as does the Massachusetts state government. The federal Equal Employment Opportunity Commission (EEOC), moreover, has paved the way for expansion of such legislation. Last December, the EEOC ruled that an insurer that failed to pick up the costs of contraceptives while paying for other preventive treatments had discriminated against women under the federal Pregnancy Discrimination Act.

Advocates here aren’t about to let legislators forget any of this. Two bills recently filed on Beacon Hill would require private health plans that offer prescription drugs to include federally approved contraceptives such as the birth-control pill, the diaphragm, intrauterine devices (IUDs), Depo-Provera (an injectable contraceptive), and Norplant (an implantable hormonal contraceptive). Both measures — currently before the legislature’s Joint Committee on Insurance, which has until June 27 to act on them — would also mandate coverage for hormone-replacement therapy, which is often prescribed for menopausal women. Senate Bill 805 and House Bill 2193, as they’re officially known, are sponsored by Senator Dianne Wilkerson and Representative Doug Petersen, respectively.

Those who attended a May 30 hearing on the bills describe a standing-room-only event during which dozens of reproductive-rights advocates, physicians, and their allies expressed ardent support. Not a single person or group testified in opposition. Things appeared to run so smoothly that many proponents left the hearing with a sure sense that, as Pam Nourse of Planned Parenthood says, “This year is going to be the year we pass contraceptive coverage.”

There’s no doubt that it should be. (The Phoenix has championed the bill as part of a 2001-’02 legislative agenda — see “Legislative Action,” Editorial, February 2.) The Massachusetts effort is not a radical proposal. It’s not even a groundbreaking proposal. Fifteen states already have comparable mandates, and some view the pending legislation as long overdue. Says Representative Ellen Story, who is pushing the bills, “We are bringing up the rear end with this issue. It’s outrageous and unbelievable that we are still having this debate.”

Indeed. But will the shame-on-Massachusetts argument finally work?

OF ALL prescription drugs, the ones that women use most are contraceptives. According to the California-based Kaiser Family Foundation (KFF), the average American woman spends about three-fourths of her reproductive lifetime — which spans the ages 15 to 45, on average — trying not to get pregnant. Those who want just two children generally must practice contraception for at least 20 years. As many as 31 million women nationwide need contraception — meaning, the KFF says, that “they are sexually active, not seeking pregnancy, and could become pregnant” without it. In Massachusetts, nine million women require such services.

Yet coverage for contraceptives remains inconsistent at best. Some private plans cover each prescription method. Others provide some services — say, paying for the examination needed to get a diaphragm (at an average cost of $80), but not the diaphragm itself (at $20). But most private insurers simply exclude contraception altogether. More than 75 percent of all plans — half of which are large group plans — don’t cover any contraceptives.

For women, this costs serious money. Consider that Norplant, which lasts five years, can cost over $700 up front. Or that the latest IUDs come with a $500 price tag. Even the popular birth-control pill costs anywhere from $21 to $45 per month. Without contraceptive coverage, women end up paying as much as 68 percent more of their own money than men for health care. That translates to between $7000 and $10,000 in out-of-pocket expenses over a woman’s reproductive lifetime.

For insurers, on the other hand, the cost of adding this coverage is minimal. The Massachusetts Group Insurance Commission (GIC), which administers health benefits for state employees, has paid for contraceptives for 15 years without, director Dolores Mitchell says, “any significant cost ramification.” Last year, the GIC spent $3.26 million on contraceptives and hormone-replacement therapy for 120,871 female members aged 15 to 100 — a mere 2.5 percent of the $131 million in overall drug spending by the agency. The GIC estimates the total annual expense per member for covering contraceptives at only $16.63, or $1.39 per month. This falls below even the paltry amount estimated by a recent Guttmacher Institute study, which concluded that including such coverage would work out to $1.43 per employee per month. Compare these numbers with the cost to insurers of a pregnancy ($3225) or an abortion ($400).

But what the issue really comes down to is equality. Only women can get pregnant, after all, and contraception is very much a “medical necessity” for most — indeed, women have no choice but to manage their fertility for three decades. Any policy that pays for the costs of basic health care for men, yet requires women to pay for contraceptives, discriminates against women and their wallets. Melissa Kogut, who heads the state chapter of the National Abortion and Reproductive Rights Action League (NARAL), notes that the pending legislation tells insurers, “If you’re going to cover prescription drugs, cover them all. Level the playing field.”

The fairness factor became apparent as soon as Viagra, the high-priced male-potency pill, hit the market in 1997. Women noticed that insurance companies were picking up this pill’s tab while refusing to pay for their pill. An August 1998 Business and Health report found that insurers were paying for Viagra three times as often as they paid for oral contraceptives. Fred Frigoletto, chief of obstetrics and gynecology at Massachusetts General Hospital, calls such a practice “blatant discrimination.” Physicians, he says, view contraception as “fundamental” for the health care of any woman — certainly as fundamental as any man’s need to treat erectile dysfunction. That health plans would eagerly cover Viagra suggests that “insurers think men’s problems are more important than women’s,” he notes.

The disparity “outraged” Petersen, who filed legislation similar to House Bill 2193 back in 1997, as did Wilkerson. Both measures received favorable reports from the Joint Committee on Insurance — but, Petersen says, got “deep-sixed” in another committee. In 1999, the legislators refiled their bills. Again, the insurance committee ruled favorably. That time, the legislation made it to the Senate floor. Senators unanimously passed it — only to see the measure languish in the House Ways and Means Committee.

THESE BILLS should have a better chance this year, however. (One State House insider remarks that insurance companies, typically opposed to any and all new government mandates, have been “remarkably quiet” about this legislation so far.) First, there’s the EEOC decision. “It’s one thing for us to say this is about discrimination,” explains Kogut. “It’s another thing for an independent federal body to say so.”

Second, there’s the state’s increasingly isolated position. Every year, legislation resembling Senate Bill 805 and House Bill 2193 wins approval nationwide. Before the current legislative session ends here, two additional states — New Mexico and Washington — will have enacted comparable measures. The trend, says Petersen, “will certainly pressure our legislative leadership.”

Support in this state, meanwhile, continues to mount. After four fruitless years, contraceptive-coverage legislation has become the top legislative priority not only for Mass NARAL, but also for the Massachusetts Coalition for Choice, which includes Planned Parenthood, the League of Women Voters, and the American Civil Liberties Union. The women’s legislative caucus has added the legislation to its four-item agenda. And 22 senators and 64 representatives have signed on. Even anti-abortion lawmakers who have long battled reproductive-rights activists support this effort. Representative Martin Walsh, a pro-life Democrat, says he embraces the legislation because it would prevent unwanted pregnancy and abortion. Explains Walsh, “It’s hypocritical for insurance companies to cover abortion services, but not cover contraceptives.” Eighty-three percent of all health plans — including the state GIC — pay for abortions these days. That statistic jumps up to 90 percent when it comes to sterilization.

For these reasons, almost everyone expects the legislation to soar through the insurance committee. “There’s no reason to think this bill will have trouble,” says Wilkerson, who serves on the committee. If so, the legislation will move on for debate in the Senate, which unanimously passed it last session.

That puts the spotlight squarely on the House — specifically, on House Speaker Tom Finneran. Some State House insiders blame the Speaker for preventing the contraceptive-coverage bill from reaching the House floor last year, although nearly 60 representatives supported it. And many observers remain convinced that the matter won’t get far while he stays at the helm. Story believes that more than enough votes exist in the House to pass the legislation — if the Speaker would schedule the bills for debate. Says Story, “The problem is not the House. It’s the Speaker of the House.” Petersen, too, predicts that representatives will have to force the issue. “I’m sure the [Catholic Church] has Finneran’s ear,” Petersen says. “I’m sure he does not want to knock [Church officials’] noses out of joint.”

Finneran hasn’t taken a public stance on the legislation. (He declined comment for this article through his spokesperson, Charles Rasmussen.) The Catholic Church, which forbids artificial contraception, has long opposed the bill, arguing that it would force the Church to violate its doctrine — which would abrogate the constitutional guarantee of religious freedom. In 1997, contraceptive-coverage proponents addressed this issue by adding a so-called conscience clause that exempts any “church or qualified church-controlled organization” — two federal definitions — from covering contraceptives. Boston archdiocese spokesperson John Walsh did not respond to the Phoenix’s questions. No one from the Church appeared before the insurance committee May 30 to speak about the bills. But Representative Ron Mariano, the committee’s co-chair, says he’s received notice from the archdiocese urging opposition. And Gerald D’Avolio of the Massachusetts Catholic Conference, the Church’s lobbying arm, told the State House News last week that the exemption does not go far enough.

What that means for this bill remains to be seen. But some legislative requirement for contraceptive coverage seems inevitable. Women, after all, have been forced to shell out for a much larger share of their medical expenses than men. And that kind of inequality is a bitter pill to swallow.

Kristen Lombardi can be reached at klombardi[a]phx.com.

Issue Date: June 7 - 14, 2001