The conversation about contraceptives often starts with chain-link fences, homemade picket signs and chanting protesters circling a government facility or health clinic.
But outside of the moral and religious debates that commonly follow birth control options, there is a heated debate between business owners, employees, women’s advocacy groups and public policy wonks nationwide.
In Louisiana, Rep. Karen Carter Peterson, a New Orleans Democrat, is drafting her second round of legislation that would require health care companies that offer prescription coverage to include FDA-approved contraceptives. While a number of health insurance companies in the state do this to some extent, there are several that leave gaps, especially for small group policyholders or individuals—a segment of policyholders known as the cost-sensitive market.
As it stands now, women spend 68% more on health care [in large part because of contraceptive costs], according to Planned Parenthood’s national statistics. The legislation is being drafted with the help of Planned Parenthood of Louisiana and the Mississippi Delta and perhaps the American Civil Liberties Union, National Council of Jewish Women and Service Employees International Union. Such groups as the National Women’s Law Center and the Alan Guttmacher Institute, a sexual and reproductive health nonprofit, back similar legislation at the federal level.
No matter what evidence advocacy groups show, opposition always rises from business owners and commerce groups because mandates beget price hikes at least based on what insurance companies are saying. But where businesses seem to get lost is that adding contraceptive coverage to an already existing prescription coverage plan saves money. Not only should it decrease—if health insurance companies were to admit cost savings—the cost of insuring many women, but it also saves business owners the costs associated with unintended pregnancies, including maternity leave, temporary employees or replacing an employee who leaves the workforce. And outside of cost savings, this legislation bridges the gap for women in health care coverage—a long-fought battle for equality in the workforce.
So why don’t businesses see this advantage? It is difficult to see how health care mandates, for any issue, save companies money when they see spikes in their health insurance premiums year after year. Pat Felder, who owns Felder’s Collision Parts with her husband, has seen drastic cost increases over the past five years. Felder says she should receive her premium statement for the next year in June, and she expects double-digit increases over last year. That’s why Felder says she can’t support the contraceptive coverage legislation.
“I would love to see health insurance companies cover contraceptives, but not through mandates,” she says. “I am adamantly opposed to any mandate at all.”
And that’s a hard line to toe for Felder, whose daughter complains that her birth control isn’t covered by prescription coverage even though Viagra and similar medications are covered under the same plan. That’s a common debating point for women’s groups that claim coverage discrimination. Health insurance companies counter that sexual dysfunction medication treats an illness, while contraceptives are preventative care.
Felder isn’t the only small business owner to feel this way. Renee Baker, the state director of the National Federation of Independent Businesses, says this is common for her constituents.
“For every little incremental increase, it typically increases the cost” to small business owners in the way of their insurance premiums, Baker says. Ultimately, the result is small companies have a tough time making it against the big guys, who barely notice the premium increases in their overall cost structures.
Baker also says mandates make it harder for companies to provide insurance for their employees. In the last year, the number of her members that provide coverage to their employees has dropped from 52% to 48%—a sign that costs might be making companies drop coverage altogether. But even Baker admits mandates aren’t the only reason health insurance companies are driving up their prices.
“I’m not going to say escalating every year in double-digit increases are only attributed to mandates,” she says. “We understand that there are other factors that play into it.”
Contraceptive coverage mandates might occur through state or federal legislation. But beyond that, they are required [though not enforced] through Title VII of the Civil Rights Act of 1964 and the 1978 Pregnancy Discrimination Act for companies with more than 15 employees. So many states acknowledge this that 24 of them have passed either legislative or executive measures to ensure that coverage is provided. And like the bill Peterson proposed last year, a number of these states included what is called a “conscience clause,” allowing religious employers to opt out of the coverage if they meet a number of requirements.
In Baton Rouge, the director of public affairs for Planned Parenthood, Julie Mickelberry, is working with their consultant as well as Peterson to educate the Legislature and the voting constituents that this type of mandate protects individuals, saves companies money and reduces costs to health insurance companies throughout the state. Mickelberry says this is “a cost-effective, common-sense, public policy measure that helps women, that helps families and saves money.”
Insurance Commissioner Jim Donelon suggests that mandates are usually well supported and beneficial for many Louisiana residents, but they always come with a cost in one way or another. “That’s the perennial tug of war between the companies that fight all mandates and their supporters.”
But even though Donelon understands the costs associated with legislation like Peterson will be filing in April, he also advocates mandates on a number of issues. He’ll be working on his own mandate for the state to swallow in the near future.
“Mandates certainly have a positive impact for those that end up being covered, but the negative impact is that they drive up costs incrementally,” Donelon says, “and that drives more of our insured population into the uninsured population.”