ATLANTA -- Now for a brief conversation about the pill. Yes, that one, the oral contraceptive that was dropped into midcentury American mores with such an impact that it was forever after known simply as the pill.
These days we have discovered a new irony on the prescription pad: The only pill your insurance may not pay for is the one we call the pill.
This is the crux of the new conversation about women's health and wealth. How did we get to a place where we treat birth control differently from all other health care?
Last week, the Georgia Legislature took up a bill that would make insurance companies pay for contraceptives if they pay for other prescription drugs. At the hearing, insurance lobbyists outweighed women's health advocates 3-to-1 and the bill was shuttled back to subcommittee. But this is an issue cropping up everywhere from Connecticut to California.
A medical necessity
It's become a reality check for women combing through the fine print of their health policies. And it's become a sincerity check for politicians who like to talk about preventing unwanted pregnancies and abortions.
Currently, 97 percent of all large group plans pay for prescription drugs, but only a third cover oral contraceptives. Meanwhile, 85 percent of insurance plans pay for sterilizations, but only half pay for any contraceptives at all.
Historically, women have had a hard time getting reproductive health care into the medical mainstream. Margaret Sanger, after all, had to smuggle diaphragms into this country in brandy bottles. Planned Parenthood began opening clinics because doctors wouldn't provide birth control.
Insurance companies have also treated reproductive health, shall we say, differently. It took an act of Congress a generation ago just to get all of them to cover pregnancy.
More to the historic point, insurers favor treatment over prevention. They have only gradually begun to cover such things as annual exams and Pap smears. They cover what is "medically necessary" and in companies where sisterhood is not yet powerful, many believe that birth control isn't necessary. In fact, some insurers will pay for oral contraceptives to treat a disease but not to plan a family. This reminds me of the wonderful yesteryears when Catholic friends were allowed to take the pill to "regulate their periods." In the early '60s, this loophole produced an epidemic of erratic periods.
But today the subject is bread and butter, as well as birth control. Women of reproductive age are paying 68 percent more than men in out-of-pocket expenses for health care. A big chunk goes to birth control. The pill alone can cost $24 a month. By comparison, it's estimated that birth-control coverage would raise premiums $16 a year.
Some women are making hard economic choices between paying their bills and buying pills, says Sen. Olympia J. Snowe, a Maine Republican. She is pushing federal legislation introduced last year by a "dream team" of abortion-rights supporters and opponents, Republican and Democratic. The Equity in Prescription Insurance and Contraceptive Coverage Act -- an EPICC moniker -- may get a hearing this election year. Meanwhile, Virginia has become the first state to pass legislation. California is in the wings, and Alaska and Connecticut are likely to follow.
This movement has given family-planning advocates a nice political jolt. As Gloria Feldt, president of Planned Parenthood, says, "A public that is very tired of arguing about abortion is more than ready to help prevent the need for it through family planning."
It's also flushed out the anti-birth-control opposition. The American Life League is fighting the idea because it "ignores the tragic physical, emotional and spiritual side effects of all contraceptives."
The remarkable part of this renewed conversation about the uninsured pill is how few women protested the hole in their coverage or their pocketbooks until now.
As for the insurance companies? Half of all the pregnancies in Georgia are unintended. Insurers may hate mandates, but why not volunteer? The pill costs about $300 a year; one birth costs about $4,000. You do the math.
As Ms. Feldt says, "they should be clamoring to pay for birth control."
Well, don't wait for the clamor.
Ellen Goodman is a syndicated columnist.
Pub Date: 3/06/98