Covering contraceptives

Twenty-five years ago insurance companies argued against covering prenatal and delivery services, based in part on the argument that pregnancy wasn’t an illness. It took recognition that health coverage was about more than paying for the treatment of illness – the federal Pregnancy Discrimination Act of 1978 also helped – to change that. Sens. Olympia Snowe and Harry Reid now properly have concluded that coverage ought to be extended to birth control as an effective preventative health measure.

The senators have proposed both keeping the contraceptive benefit in coverage for federal employees and requiring it of all insurers that offer prescription drug coverage. The coverage is important because, as study by the Kaiser Family Foundation found a couple of years ago, three-fourths of adult women say cost is important to them when choosing a type of contraception or, for a few, whether to use contraception at all. The risk of unintended pregnancy is increased by a lack of health coverage, adding significantly to the cost of coverage.

In fact, after the Federal Employees Health Benefits program was required to cover FDA-approved prescriptions and devises for birth control in 1999, the Office of Personnel Management monitored the costs of the added benefits. The benefit program covers 9 million employees, retirees and their families and includes some 300 health plans and approximately $18 billion in benefits annually. “We told health carriers we would adjust 1999 premiums, if needed during the 2000 premium reconciliation process,” wrote Personnel Management Director Janice R. Lachance last winter. “However, there was no need to do so since there was no cost increase due to contraceptive coverage.” Other organizations, such as the Allan Guttmacher Institute, have found similar cost results.

That is, the savings from the avoided cost of unintended pregnancies offset the cost of providing this benefit to everyone. Though proposed by Sens. Snowe and Reid in 1998 and approved a year later, President Bush unfortunately stripped it from the health program this year.

Similarly, while cost-conscious health-maintenance organizations are likely to include the benefit in its offerings, traditional fee-for-service plans less likely to, leaving coverage uneven at best.

In offering this proposal a couple of years ago, Sen. Snowe observed that many women could get prescription coverage for allergy medicine more readily than “a prescription to prevent an unintended and life-altering pregnancy.” Then, the lack of coverage for contraceptives was highlighted by the rush to cover the drug Viagra. Now, the cost data add emphasis to a disparity that is absolutely unnecessary. The two senators are right to keep pressing this issue, and their colleagues should support the proposals to include contraceptives in health coverage.