Regulators will mandate insurance coverage of birth-control

Posted: Thursday, August 23, 2001

OLYMPIA -- Lois Walker says it's a simple matter of fairness: If men get their Viagra prescriptions covered by insurance, why do many women have to pay for birth-control pills out of pocket?

State Insurance Commissioner Mike Kreidler says he buys the gender equity argument. Indeed, state and federal anti-discrimination laws compel him to make Washington the 15th state to require most insurance companies to provide contraceptive coverage, he said Wednesday after a hearing on the change.

The new mandate will extend birth-control coverage to at 200,000 more women.

Testimony at a public hearing in Olympia was mixed, but Kreidler said he heard nothing that derails his plan to impose the mandate, effective New Year's Day. He said he personally supports the change, and, more importantly, the state violates anti-discrimination laws without evenhanded treatment of women.

The new regulation says that any insurance carrier that offers comprehensive prescription drug coverage must cover prescription contraceptive devices and services, including birth control pill, IUDs, diaphragms, implants and injectable contraceptives.

The cost is estimated at $17.12 a year for an employer and $4.28 a year for a worker. For plans already offering coverage of the pill, the extra premium for expanding to all approved forms of prescription birth control is estimated at $1 per employee per year.

Condoms and spermicide, both sold over-the-counter, are not included in the commissioner's plan.

The coverage guarantee will be written into policies as they come up for their annual renewal next year. Most policies renew on Jan. 1, Kreidler said.

Many policies now cover at least some prescription contraceptives, but some group plans do not, leaving ''well over 200,000'' women uncovered, he said.

The federal Equal Employment Opportunity Commission ruled last December that such an exclusion discriminates based on gender. U.S. District Judge Robert Lasnik in Seattle held in June that it is discriminatory to deny contraceptive coverage while covering other prescription drugs.

Testimony at the hearing was mixed.

A parade of women's groups applauded the new mandate. But representatives of small business owners said the change will be yet another expense that may cause employers to simply drop medical coverage of their workers.

Walker, who lives on Hartstene Island, said insurance companies tend to be patriarchal, and some use the phrase ''medically necessary'' as a loophole to deny coverage of birth-control and other women's services.

''Is Viagra (the impotence drug) 'medically necessary' to a man's good health? The benefits last only an hour or two. The benefits of birth control last a lifetime,'' she told the administrative hearing Kreidler held en route to enacting the change.

Denying coverage is ''absolutely discriminatory,'' said Marcy Bloom, director of Aradia Women's Health Center in Seattle.

''It is very bad medicine and it is poor public policy,'' she said.

''Washington citizens want insurance inequity to be addressed,'' said Karen Cooper, director of Washington National Abortion and Reproductive Rights Action League. ''They want the health care system to provide the full range of contraceptives that prevent unintended pregnancy and thus reduce the need for abortion.''

She and other witnesses urged Kreidler to beef up the new regulation to eliminates phrases, like ''medically necessary,'' that companies might use to deny coverage.

Roberta Riley of Planned Parenthood said some companies hassle women. ''Why is a doctor's prescription never enough when it comes to women's contraceptive needs?'' she said.

''For us, this is a critical aspect of a woman's right to control her destiny,'' said Lonnie Johns-Brown of the National Organization for Women. The cost of providing contraceptives is much less than paying the costs of an unwanted pregnancy, she said.

Constance Daruthayan, a University of Washington senior, said paying $200 or $300 a year for birth control is a burden for ''someone who barely makes ends meet.''

But others said the commissioner has no authority to mandate a new coverage and that costs will drive some employers out of the insurance market.

''Nothing's for free,'' said Mel Sorensen of the Employer Health Care Coalition.

The Legislature, not the commissioner, should decide mandates like this one, he said.

Washington's Legislature did approve birth-control coverage for individual policies, but never has extended that to the group market, he said.

''For some businesses out there, this is going to be too much,'' said Carolyn Logue, state director of the National Federation of Independent Business. ''Even $1 for some of our members is too much.''

Rather than heaping on new mandates, the state should try to make health care more affordable for more people, she said.

Other witnesses said coverage should be optional, not mandatory. Evelyn Castellar, Federal Way, told the audience she is battling breast cancer and that insurance should be focused on treating major illness, not lesser concerns like birth control.

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On the Net:

Kreidler: http://www.insurance.wa.gov



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