IEET Author on Technology Shift in Publicly Funded Contraception Experiment

Over at the Institute for Ethics and Emerging Technologies, Valerie Tarico wrote an interesting analysis of a St. Louis program that adopted an Obamacare-like approach to contraception. According to a US News & World Report article on the program,

Through a project known as Contraceptive CHOICE, nearly 10,000 women between the ages of 14 and 45 in the St. Louis and Kansas City, Mo., areas were offered free contraceptives between 2007 and 2011. Abortion rates among that cohort were between two thirds and three quarters less than the national average for those years. For the 500 teens in the study, the birth rate was 1-in-159, compared to the 1-in-29 birth rate nationally–an 80 percent drop.

That’s an astounding reduction in teen pregnancies. What’s even more interesting, and the focus of Tarico’s article, is that the reason for the drop appears to be that the women in the study opted to shift from less reliable to more reliable forms of birth control.

But the real story is even bigger. What got triggered when 9000 women were offered free birth control was a technology shift in a microcosm. When presented with comprehensive information and a buffet of no-cost options, a majority of the study’s participants, almost 75%, shifted from 1960’s contraceptive technologies to state-of-the-art long acting reversible contraceptives known in the industry as LARCs. And they liked them!

. . .

In the real world, long acting reversible contraceptives have 1/10 to 1/50th the failure rate of Pills, and they are cheaper in the long run. But the upfront cost is substantial, as much as $1000 for the device and insertion. The result is that women who are living month to month often choose old technologies and then pay the price, and even middle class women with health insurance may balk at the lump sum. Taking the money out of the equation changes the bottom line.

I tend to be very libertarian but clearly this is a case where the initial government spending may be far outweighed by later savings (i.e., government expenditures on pregnant teens and their children). Regardless, it is interesting just how stupid the response from the Family Research Council to the study was. US News quotes FRC’s Jeanne Monahan,

One might conclude that the Obama administration’s contraception mandate may ultimately cause more unplanned pregnancies since it mandates that all health plans cover contraceptives, including those that the study’s authors claim are less effective.

The stupid, it burns.

Contraception Mandates by State

An interesting table from the National Conference of State Legislatures listing contraception mandates by state. Currently, 26 states have some sort of mandate that contraception be offered by health insurance plans:

 For more information, please see the State Policies in Brief on Insurance Coverage of Contraceptives by the Guttmacher Institute, which features a state chart of coverage mandates.


 Summary of Statutes

Arizona * Ariz. Rev. Stat. Ann. § 20-2329 (2002) requires all health insurance plans providing coverage for prescription medications to also provide coverage for all FDA-approved prescription methods of contraception. Religious employers may request exclusion from this requirement.(HB 2234)
Arkansas * Ark. Stat. Ann. § 23-79-1103-1104 (2005) requires all health insurance plans providing coverage for prescription medications to also provide coverage for all FDA-approved prescription methods of contraception. This requirement does not cover emergency contraception. Religious employers are not required to comply with this policy.(2005 Ark. Acts, Act 2217; HB 2618)
California * Cal. Insurance Code § 10123.196 and Cal. Health & Safety Code § 1367.25 (1999) require certain health insurance policies that already cover prescription drugs to provide coverage for prescription contraceptive methods approved by the FDA. Religious employers can request health insurance plans without coverage of approved contraceptive methods that are contrary to the employer’s religious tenants. (AB 39)
 Colorado Colo. Rev. Stat. § 10-16-104 (2010) requires specified health insurance plans to provide coverage for contraception in the same manner as any other sickness, injury, disease, or condition is otherwise covered under the policy or contract. (2010 HB 1021)
Connecticut * Conn. Gen. Stat. § 38a-530e (1999) requires insurers that offer prescription drug coverage to include coverage for contraceptives. Upon written request of an individual whose moral or religious beliefs are contrary to prescription contraceptive usage, the insurance company, hospital or medical service corporation, or health care center can exclude coverage for prescription contraceptive methods. (Conn. Acts, P.A. 99-79; HB 5950)
Delaware * Del. Code Ann. tit. 18, § 3559  (2000) requires insurers that provide coverage for outpatient prescription drugs to provide coverage for prescription contraceptive drugs and devices. A religious employer can request exclusion of coverage under this policy if coverage conflicts with the religious organization’s beliefs or practices. A religious employer that obtains this exclusion must provide its employees reasonable and timely notice of the exclusion. (Vol. 72 Del. Laws, Chap. 311; SB 87)
Georgia Ga. Code § 33-24-59.6 (1999) requires insurers that offer prescription drug coverage to include contraceptives.
Hawaii * Hawaii Rev. Stat. § 432:1-604.5 and § 431:10A-116.6 (1999) direct that employer group health policies, contracts, plans or agreements must cease to exclude contraceptive services or supplies, including FDA-approved contraceptive drugs or devices to prevent unwanted pregnancy, and must not charge unusual co-payments or impose waiting requirements. (1999 Hawaii Sess. Laws. Act 267; SB 822)Hawaii Rev. Stat.  § 431:10A-116.7 (1999) defines a religious employer and states that such an employer may request a health insurance plan without coverage for contraceptive services and supplies. If so requested, the health insurer must provide a plan without such coverage.  Each religious employer that invokes this exemption must provide written notice to enrollees upon enrollment a list of services the employer refuses to cover and provide written information describing how an enrollee may access contraceptive services and supplies.  (1999 Hawaii Sess. Laws. Act 267; SB 822)
Illinois Ill. Rev. Stat. ch. 215 § 5/356z.4, § 125/5-3 and § 165/10 (2003) require coverage to include outpatient prescription contraceptive drugs, devices and outpatient contraceptive services without imposing limitations. (2003 Ill. Laws, P.A. 93-0102; HB 211) 
Iowa Iowa Code § 514C.19 (2000) prohibits specified health insurance plans, including a public employer plan, that provides benefits for outpatient prescription drugs, devices or services from excluding or restricting benefits for FDA-approved prescription contraceptive drugs, devices or outpatient services. (2000 Iowa Acts, Chap. 1120; SB 2126)
Maine * Me. Rev. Stat. Ann. tit. 24 § 2332-J and Me. Rev. Stat. Ann. tit. 24a § 4247 (1999) require insurers that provide coverage for prescription drugs and outpatient medical services to provide coverage for all prescription contraceptives and outpatient contraceptive services. A religious employer may request exclusion from these coverage requirements, and needs to provide insured employees a written notice of the exclusion.
Maryland * Md. Health-General Code Ann. § 19-706 and Md. Insurance Code Ann. § 15-826 (1998) require private insurers to provide comprehensive coverage for contraceptives.  Religious organizations may request exclusion from this policy.
Massachusetts * Mass. Gen. Laws Ann. ch. 175 § 47W, ch. 176A § 8W, ch. 176B § 4W, and ch. 176G § 4O (2002) require insurers that provide benefits for outpatient services to also provide hormone replacement therapy for menopausal women and outpatient FDA-approved contraceptive services under the same terms and conditions as for other outpatient services. The law defines outpatient contraceptive services. This law excludes policies purchased by an employer that is a church or a qualified church-controlled organization. (2002 Mass. Acts, Chap. 49; SB 2139)
Missouri * Mo. Rev. Stat. § 376.1199 (2001) requires health carriers that provide pharmaceutical coverage to include coverage for contraceptives, excluding drugs and devices that are intended to induce an abortion. The law clarifies that coverage for prescriptive contraceptive drugs or devices is not excluded if prescribed for other diagnosed medical conditions. The law exempts specified insurance policies, including health carriers owned and operated by religious entities, from the provisions of the law. The law prohibits discrimination against an enrollee because of the enrollee’s request regarding contraceptive coverage. The law requires carriers to maintain the confidentiality of any individual’s request for contraceptive coverage. (HB 762)
Nevada * Nev. Rev. Stat. § 689A.0417, § 689B.0377, § 695B.1918, and § 695C.1695 (1999) require insurers that offer prescription drug coverage to include coverage for contraceptives. Religiously affiliated organizations are not required to provide contraceptive coverage.
New Hampshire N.H. Rev. Stat. Ann. § 415:18-I, § 420-A:17-c and § 420-B:8-gg (1999) require health insurers, health service corporations and health maintenance organizations to provide coverage for outpatient contraceptive services. The law also states that health insurers that provide prescription riders must cover all prescription contraceptive drugs and prescription contraceptive devices approved by the FDA under the same terms and conditions as other prescription drugs.
New Jersey * N.J. Stat. Ann. § 17:48-6ee, § 17:48A-7bb, § 17:48E-35.29, § 17:48F-13.2, § 17B:26-2.1y§ 17B:27-46.1ee, § 17B:27A-7.12, § 17B:27A-19.15§ 26:2J-4.30; § 52:14-17.29j (2005) require all health insurance or medical providers to cover prescription female contraceptive drugs and devices in the same way that other prescription drugs are covered. Religious employers and organizations may be granted an exception. They must provide written notice to their current and prospective subscribers about this exemption.
New Mexico * N.M. Stat. Ann. § 59A-22-42 and § 59A-46-44 (2003) require each individual and group health insurance policy, health care plan and certificate of health insurance that provides a prescription drug benefit to provide coverage for prescription contraceptive drugs or devices. A religious entity purchasing health insurance coverage can elect to exclude prescription contraceptive drugs or devices from health coverage. (SB 557)N.M. Stat. Ann. § 59A-22-42 (2001) requires specified insurance plans to offer coverage for prescription contraceptive drugs or devices, which may be subject to deductibles and coinsurance. (2001 N.M. Laws, Chap. 14; HB 59)
New York * N.Y. Insurance Law § 4303 (2002) requires insurers that provide coverage for prescription drugs to include coverage for the cost of contraceptive drugs or devices approved by the FDA.  Religious employers are allowed to deny employees contraceptive coverage provided that employees are informed in writing of such exclusions. Most insurers must provide written notice to enrollees of their right to directly purchase, for an additional premium at the small group community rate, a rider for coverage of contraceptives. (AB 11723)
North Carolina * N.C. Gen. Stat. § 58-3-178 (1999) requires insurers that offer prescription drug coverage to include coverage for contraceptives and outpatient contraceptive services. A religious employer may request a health benefit plan that excludes coverage for prescription contraceptives drugs and devices that are contrary to the employer’s religious tenets.
Ohio Ohio Rev. Code Ann. § 1751.01 A7 requires health insurance corporations to provide basic health services, including medically necessary voluntary family planning services.
Oregon * Or. Rev. Stat. § 743A.066 (2007) specifies that a prescription drug benefit program, or a prescription drug benefit offered under a health benefit plan or under a student health insurance policy, must provide payment, coverage or reimbursement for prescription contraceptives and outpatient consultations, examinations, procedures and medical services that are necessary to prescribe, dispense, deliver, distribute, administer or remove a prescription contraceptive. A religious employer is exempt from these requirements. (2007 Or. Law, Chap. 182, HB 2700)
Rhode Island * R.I. Gen. Laws § 27-18-57, § 27-19-48, § 27-20-43 and § 27-41-59 (2000) require specified health insurance plans that provide prescription coverage to also provide coverage for FDA-approved prescription contraceptive drugs and devices. A religious employer providing health insurance may exclude coverage for prescription contraceptive methods which are contrary to the employer’s bona fide religious tenets. (2000 R.I. Pub. Laws, Chap. 120; SB 2367)
Texas * Tex. Insurance Code Ann. § 1369.104 et seq. (2001) prohibit a health benefit plan that provides benefits for prescription drugs or devices from excluding prescription contraceptives approved by the FDA. The law does not apply to coverage for abortifacients or any other drug or device that terminates a pregnancy. The law prohibits a health benefit plan from imposing cost-sharing provisions on prescription contraceptives. The law states that a health benefit plan may not impose any waiting period for prescription contraceptives. The law does not require a health benefit plan associated with a religious organization to offer a medical or health care service that violates the religious convictions of the organization, except if the prescription contraceptive coverage is necessary to preserve the life or health of the insured individual. (HB 2382)
Vermont Vt. Stat. Ann. tit. 8 § 4099c  (1999) requires health insurance plans to provide coverage for contraceptives if they cover prescription drugs.
Virginia Va. Code § 2.2-2818(B)(5), § 32.1-325 and § 38.2-3407.4:2 (2001) require that the health and related insurance for state employees include coverage for prescription drugs and devices used as contraceptives. (2001 Va. Laws, Chap. 334; H 2654)Va. Code § 38.2-3407.5:1 (1997) requires insurers that provide coverage for prescription drugs to offer and make available coverage for FDA-approved contraceptive drugs or devices, at the option of the purchaser. This law is not a mandate for coverage.
Washington Wash. Rev. Code § 48.41.110 (2007) requires health insurance policies issued by the state health insurance pool to provide coverage for drugs and contraceptive devices requiring a prescription.
 Wisconsin Wis. Stat. § 609.805 and § 632.895(17) (2009) require that insurance policies and self-insured health plans that provide coverage for outpatient health care services, preventive services or prescription drugs and devices also provide coverage for contraceptives prescribed by a health care provider. The law also requires that any outpatient services that are necessary to prescribe, administer, maintain or remove a contraceptive be provided if such services are covered for any other drug benefits. These requirements do not apply to disability insurance policies that provide only limited-scope dental or vision benefits, long-term care insurance or Medicare replacement or supplemental policies. (2009 Wis. Laws, Act 28; AB 75)
West Virginia * W. Va. Code § 33-25A-2(1), (11) (1996) requires HMOs to provide or make available basic health care services that encompass coverage for voluntary family planning services.W. Va. Code § 33-16E-1 et seq. (2005) require prescription drug parity; all health plans and medical service organizations must cover FDA-approved prescription drugs and devices under the same guidelines they cover other prescription drugs.  Extraordinary surcharges are prohibited. Religious employers may be exempt, but must provide potential or current subscribers written notice of the policy and make arrangements for them to purchase drugs or devices at the prevailing group rate from another provider. The law excludes coverage of a dependent child. The law does not apply to Medicaid.

Sources:  National Conference of State Legislatures and the Guttmacher Institute.

Note: List may not be comprehensive, but is representative of state laws that exist. NCSL accepts additions and  updates to this report.

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