In the last few years, more lawmakers have considered legislation
to require contraceptive coverage in private insurance. For
instance, from 1997 through 1999, the number of contraceptive
coverage bills introduced in the state legislatures increased by 379
1998, 13 states have enacted laws to address the imbalance in
prescription contraceptive coverage in private insurance:
California, Connecticut, Delaware, Georgia, Hawaii, Iowa, Maine,
Maryland, Nevada, New Hampshire, North Carolina, Rhode Island, and
Although state laws will help many women, they cannot ensure
coverage throughout the United States. Not all states will require
coverage, and even in states that do, not all women who have private
insurance will be covered. In fact, over half of all U.S. workers
are covered under a health insurance plan regulated by the Employee
Retirement Income Security Act (ERISA) and thus exempt from state
Federal legislation will be necessary to ensure nationwide private
health insurance coverage for contraception.
The Equity in Prescription Insurance and Contraceptive Coverage
Act (EPICC), which would require parity in coverage for
contraceptive prescriptions and medical services under those plans
not subject to state regulation, was introduced in both the 105th
Congress and the 106th Congress, but has not yet been brought to the
House or Senate floor.36
This type of legislation is critical to ensuring more equitable
private health insurance coverage, and in eliminating barriers to
more effective family planning.
Rachel Benson Gold, Jacqueline E. Darroch, and Jennifer J. Frost,
"Mainstreaming Contraceptive Services in Managed Care – Five States’
Experiences," Family Planning Perspectives, vol. 30, no. 5
(Sept./Oct. 1998): 204. In 1998 -- and again in 1999 -- Congress
took an important step forward in providing equitable coverage for
contraception in federal employee health benefit plans, and some
states have ensured that women covered under state employee health
benefit plans have contraceptive coverage. 145 Cong. Rec. H 5612-01,
5619, FY 2000 Treasury, Postal, and General Government
Appropriations Act, Pub. L. 106-58, § 635; The NARAL
Foundation/NARAL, Insurance Inequities: A State-By-State Review
of Contraceptive Coverage, 1999 (Washington, D.C.: The
NARAL Foundation/NARAL, 1999), 13. The same arguments set forth in
this memorandum regarding private insurance apply with equal vigor
in the public employee insurance context.
The Alan Guttmacher Institute (AGI), Uneven and Unequal:
Insurance Coverage and Reproductive Health Services (New York:
AGI, 1994), 9.
AGI, Uneven and Unequal, 12, 15. A 1999 survey of employers
found that although 96 percent of employees in traditional insurance
plans have prescription drug benefits, only 54 percent have coverage
for oral contraceptives. An even smaller percentage of employees --
39 percent -- have coverage for oral contraceptives and Norplant,
IUDs, and diaphragms. Kaiser Family Foundation (KFF)/Health Research
Education Trust (HRET), Employer Health Benefits: 1999 Annual
Survey, (Washington, D.C.: KFF, 1999), 84.
Oral Contraceptives are generally not recommended for women with the
following characteristics: smoker, sedentary, overweight, over 50
years of age, history of heart or vascular disease, diabetic, or
high cholesterol level. Robert A. Hatcher et al., Contraceptive
Technology, (New York: Irvington, 1994), 235.
AGI, Uneven and Unequal, 17-19.
Rachel Benson Gold and Cory L. Richards, Improving the Fit:
Reproductive Health Services in Managed Care Settings (New York:
AGI, 1996), 14. According to the 1999 KFF/HRET survey, while 80
percent of employees in HMOs have coverage for oral contraceptives,
only 58 percent of these employees also have coverage for Norplant,
IUDs, and diaphragms. KFF/HRET, Employer Health Benefits,
Benson Gold and Richards, Improving the Fit, 14.
AGI, Uneven and Unequal, 17. The 1999 KFF/HRET survey of
employers found that although nearly two-thirds (64 percent) of PPO
plans cover oral contraceptives, fewer than half (44 percent)
provide coverage for Norplant, IUDs, and diaphragms. As for POS
networks, 67 percent provide coverage for oral contraceptives, but
only 60 percent provide coverage for Norplant, IUDs, and diaphragms.
KFF/HRET, Employer Health Benefits, 82, 84.
AGI, Uneven and Unequal, 15.
Connecticut NARAL survey, "Comprehensive Survey of Health Insurance
Providers in Connecticut," 1998.
NARAL-PA Foundation, A Special Report on Insurance Coverage of
Reproductive Health Care in Pennsylvania (Philadelphia: NARAL-PA
Foundation, June 1998), 6-7.
Deborah Senn, Washington State Insurance Commissioner,
Reproductive Health Benefits Survey (Olympia: OIC, Sept.
Illinois Women’s Health Coalition, "Does Managed Care Serve Women?
Insurance Coverage of Reproductive Health Care in Illinois"
(Oct. 1999), 4,6.
Women's Research and Education Institute (WREI), "Women's Health
Care Costs and Experiences," Executive Summary (1994), 2-3.
The Auditor, State of Hawaii, "Study of Proposed Mandatory Health
Insurance Coverage for Contraceptive Services," Feb. 1998, 11
(Report to the Governor and the Legislature of the State of Hawaii).
AGI, Uneven and Unequal, 4.
Kaiser Family Foundation, Kaiser Family Foundation National
Survey on Insurance Coverage of Contraceptives, Questionnaire
and Topline (Menlo Park: KKF, June 19, 1998).
Quinnipiac College Poll, "Connecticut Votes Back Birth Control
Insurance 4-1, Quinnipiac College Poll Finds; Lieberman Gets Strong
Approval From Republicans," Apr. 2, 1998 (press release).
Family Planning Advocates of NYS, "New York State Poll Results, New
York Voters Support Contraceptive Coverage Equity, Legislature
Should Pass Bill That Would Require Health Plans That Cover
Prescriptions To Cover Prescription Birth Control," June 18, 1998
Scripps Howard Texas Poll, June 1998 (on file with NARAL).
Stanley Henshaw, "Unintended Pregnancy in the United States,"
Family Planning Perspectives, vol. 30, no. 1 (Jan./Feb.
James Trussell, et al., "The Economic Value of Contraception: A
Comparison of 15 Methods," American Journal of Public Health,
vol. 85, no. 4 (Apr 1995): 500.
Trussell, "The Economic Value," 497, 500.
Utah Office of Health Data Analysis, The Utah Health Data Committee
1998 Biennial report (Dec. 1998)
<http://www.healthdata.state.ut.us> (Feb. 8, 1999).
Jacqueline Darroch, Cost to Employer Health Plans of Covering
Contraceptives, Summary, Methodology and Background (New York:
AGI, June 1998), 1.
Rachel Benson Gold, "The Need for the Cost of Mandating Private
Insurance Coverage of Contraception," The Alan Guttmacher Report
on Public Policy (Aug. 1998): 5.
144 Cong. Rec. S9194 (daily ed. July 19, 1998).
Suzanne Delbanco, et al., "Public Knowledge and Perceptions About
Unplanned Pregnancy and Contraception in Three Countries," Family
Planning Perspectives, vol. 29, no. 2 (Mar./Apr. 1997): 72.
Committee on Unintended Pregnancy, Best Intentions, 136;
Elise F. Jones et al., Pregnancy, Contraception, and Family
Planning Services in Industrialized Countries (New Haven, CT:
Yale University Press, 1989), 218-19 (study by AGI).
Committee on Unintended Pregnancy, Best Intentions, 81.
The National Commission to Prevent Infant Mortality, Troubling
Trends: The Health of America's Next Generation, (Washington,
DC: National Commission to Prevent Infant Mortality, 1990), 25.
The NARAL Foundation/NARAL, Who Decides? A State-By-State Review
of Abortion and Reproductive Rights, 1999, 8th Edition
(Washington, D.C.: The NARAL Foundation/NARAL, 1999), xii; The NARAL
Foundation/NARAL, Who Decides? A State-By-State Review of
Abortion and Reproductive Rights, 2000, 9th Edition (Washington,
D.C.: The NARAL Foundation/NARAL, 2000), vii.
In 2000, three states -- Delaware, Iowa, and Rhode Island -- enacted
bills requiring insurance coverage of contraceptives. IA SF 2126
(2000), DE SB 87 (1999), RI SB 2367 (2000). In 1999, ten bills were
enacted in 9 states: CA AB 39, CA SB 41, CT HB 5950, GA HB 374, HI
SB 822, ME SB 389, NV AB 60, NH SB 175, NC SB 90, and VT HB 189.
Maryland enacted a contraceptive equity law in 1998. Ch. 117, 1998
Md. Adv. Legis. Serv. 449 (Michie) (to be codified at §§15-826,
19-706). See also, The NARAL Foundation/NARAL, Who
Decides? A State-By-State Review of Abortion and Reproductive
Rights, 2000, 9th Edition (Washington, D.C.: The NARAL
Texas requires insurers that provide coverage for prescription drugs
to provide coverage for oral contraceptives. 28 Tex. Admin. Code §§
21.403, .404(3)(1999). Minnesota, New Jersey, and Wyoming require
HMOs to cover voluntary family planning services. Minn. R.
4685.0100, subp. 5, Minn. R. 4685.0700, subp. 1 (1997 & Supp.
1999); N.J. Admin. Code tit. 8, § 38-5.4 (June 16, 1997); WCWR
044-000-013 §§ 3, 7(c)(ii)(B) (Feb. 1997). Three states require
insurers to offer at least one plan in the individual and small
group markets that provides coverage for contraception (ID, KY, NJ).
Ky. Rev. Stat. Ann. § 304.17A-250 (Lexis Supp. 1998); Tit. 806
Admin. Regs. 17:180 (1999); N.J. Admin. Code tit. 11, § 20-3.1, App.
Exh. A-F (April 19, 1999), N.J. Admin. Code tit. 11, § 21-3.1, App.
Exh. F&G (Oct. 19, 1998); see also, The NARAL Foundation/
NARAL, Who Decides? A State-By-State Review of Abortion and
Reproductive Rights, 1999, 9th Edition (Washington, D.C.: The
NARAL Foundation/NARAL, 2000).
United States General Accounting Office, "Health Insurance
Regulation: Wide Variation in States' Authority, Oversight and
Resources," Dec. 1993, 5. (Report to the Chairman, Subcommittee on
Health, Committee on Ways and Means, House of Representatives).
"Equity in Prescription Insurance and Contraceptive Coverage Act of
1997," H.R. 2174 (1997); "Equity in Prescription Insurance and
Contraceptive Coverage Act of 1999," H.R. 2120 (1999), S. 1200