Who Will Pay? Insurers May Have to Ante Up

A new day may be dawning for birth control and insurance coverage.

Truth be told, contraception has never been a priority for health insurers. As strange as it sounds, most companies have been more willing to pay for surgery—tubal ligations, vasectomies and abortions—than less expensive methods like the birth control pill, Depo-Provera, Norplant, the IUD and the diaphragm. Eighty-six percent of indemnity plans cover tubal ligations, for instance, and 85 percent cover vasectomies, according to the Alan Guttmacher Institute. Only 33 percent cover the pill.

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This year, the issue finally became part of the discourse in Congress. Passage of legislation that would require all insurers of federal employees that cover prescription drugs to also cover prescription birth control seems imminent. As a result, bipartisan bills that would apply similar standards for the general public, ignored for months, have found new life in both houses of Congress.

“The cost of covering contraception for a woman for a year is about $300,” says Judith DeSarno, president of the National Family Planning and Reproductive Health Association. “The cost of a healthy delivery—forget prenatal care—is $3,600. And if you have a Cesarean section, it’s $10,000. You would think that insurance companies and the U.S. Congress would understand just the economic sense of making contraception as available and as affordable as possible. It’s just darn good policy.”

Another powerful argument has been that insurers routinely cover other prescription drugs, but not birth control. As a result, poor women in particular will often choose less expensive, less reliable methods. “Women in this country should not be forced to choose among such unacceptable alternatives,” said Planned Parenthood’s Gloria Feldt, when she appeared before Congress this summer.

Apparently, the American public agrees. In a survey last spring, the Kaiser Family Foundation found that of the respondents familiar with the Congressional bills that would provide birth-control coverage for the general public, 75 percent “strongly supported” or “somewhat supported” them.

Insurance companies have responded true to form. “Insurers oppose mandates because they raise costs for consumers and can ultimately price consumers out of the insurance market,” says Richard Coorsh, a spokesman for the Health Insurance Association of America, which represents 250 private insurers. “Already on the state level there exist some 1,200 mandated benefit requirements. I’ve yet to come across any advocacy organization suggesting that their particular mandate is not cost effective.”