Contraception is a critical issue for women of all ages and social class because the decision to have a baby impacts a woman’s physical, mental, and emotional health. Contraception is also very costly and is an expense that a woman primarily shoulders. Not every employer’s health insurance plan provides benefits for prescription contraceptives and devices. A personal survey of 50 adults with varying types of insurance plans, asked if their health insurance plans provided coverage for birth control, Viagra, or abortion.
Everyone surveyed maintain that his plan provides coverage for Viagra, a sexual enhancement drug, and abortion. The same survey showed that 26% of the insurance plans do not provide benefits for Food and Drug Administration (FDA) approved prescription contraceptives or devices for the solitary purpose of preventing pregnancy (personal communication, 2010). Not providing coverage for birth control, yet providing coverage for other types of prescription drugs, services, and devices, is discriminatory against women and has a negative impact on an employer’s and the government’s economics.
The federal government should mandate that all health care plans provide coverage for FDA approved contraceptives because not providing them is discriminatory against women. Preventive Health Care and Finance Women that plan their pregnancies usually obtain pre-natal care and take better care of themselves and unborn child. Moreover, women who have planned their families put enough distance between each pregnancy so not to put a strain on their physical, mental, and emotional welfare. This is better for both mother and child.
Furthermore, to obtain FDA approved prescription birth control, women must first be seen be a licensed physician and have an examination. That examination includes a Pap smear, breast exam, and screening for sexually transmitted diseases. Without the motivation of obtaining contraception, women may not schedule an exam that could detect, and treat, potentially life-threatening diseases. Early detection of disease, such as cervical and breast cancer, is vital to making a full recovery.
Family planning devices and prescriptions should be a benefit that all health insurance plans provide because more than half of the pregnancies that occur within this country are not planned. The United States has the highest rate of accidental pregnancies of the entire industrialized world. Of those pregnancies, only half come to term. The other pregnancies end because of spontaneous abortion, also known as miscarriage, or the woman elects to have an abortion (Roan, 2009).
With insurance provided birth control these statistics can decrease considerably. Lack of coverage, and the out-of –pocket expense for birth control, is a factor in the high rate of unintended pregnancies because women are going without birth control, or opt for less effective methods for family planning. Women spend approximately two-thirds of their lives in an attempt to avoid pregnancy, but still a majority of women experience an unplanned pregnancy by the time they reach age 45 (Vargas, 2002).
Women are primarily responsible for preventing pregnancy and rely on prescribed contraceptives and devices because there is no effective form of over-the-counter birth control available for women’s use. The most effective form of birth control, other than abstinence, is oral contraceptives, which is better known as “the pill. ” With insurance, co-payments for the pill range from $10 to $50 per month (Andrews, 2010). Without insurance coverage, the expense of the pill can range from $20 to $75 per month. Over a 25-year period this could amass from $6,000 to well over $20,000 (Guttmacher, 2010).
Therefore, women are paying upwards of 68% higher health care expenditures than their male counterparts (Zolman, 2002). In comparison, the only form of birth control used by men is a condom, and they are available without prescription and not costly. Pictured above are different types of birth control available. All, except condoms, require a prescription and are used by women. Photo courtesy of Dawn Stacey Sexual Discrimination Some health insurance plans exclude contraceptives because it views them as quality of life drug and not medically necessary.
If a doctor deems a woman to have a clinical need for contraception, such as recurring headaches, endometriosis, acne, or irregular menstruation, an insurance company may choose to authorize benefits. However, Viagra is one quality of life drug that insurance plans cover without question (Vargas, 2002). Viagra is an oral treatment that a doctor prescribes exclusively to men who suffer from erectile dysfunction. Covering expenses for one quality of life drug, aimed for the improvement of men’s sex lives, and denying benefit of another quality of life drug, intended to prevent pregnancy for women, is undoubtedly discriminatory.
The Equal Employment Opportunity Commission (EEOC) sustain employers are legally bound to provide a full range of family planning options if other forms of preventive health prescriptions and devices are part of their benefits package. Title VII of the Civil Rights Act of 1964 says it is unlawful when employers “fail or refuse to hire or discharge any individual, or otherwise discriminate against any individual with respect to his compensation, terms, conditions, or privileges of employment because of such individual’s race, color, religion, sex, or national origin” (Zolman, 2002, p. 8). Health and prescription coverage is part of the compensation and terms of employment as mentioned in Title VII. To provide further clarification, the United States government added an amendment in 1978 called the Pregnancy Discrimination Act (PDA), and it reads “…women affected by pregnancy, childbirth, or related medical conditions shall be treated the same for all employment related purposes, including of receipt of benefits under fringe benefit programs” (Vargas, 2002, p. 9).
The current regulations for health insurance governance vary and are subject to different protocol. The Employment Retirement Security Act (ERISA) is a federal law that oversees self-funded insurance plans. A self-funded insurance plan, also known as self-insured, is a plan that an employer provides and pays for from a self-established fund. ERISA oversees the compliance of procedure, such as providing insurance information and instructions on how to file grievances, however; it does not require employers to provide specific benefits (Zolman, 2002).
Within ERISA is a loophole that self-funded insurance plans have used to avoid following mandates that may be in effect through state legislation. Fully insured health plans contract through insurance brokers, are subject to state insurance mandates, and are not governed by ERISA (Zolman, 2002). The Equity in Prescription Insurance and Contraceptive Coverage Act (EPICC) is a federal contraceptive prescription and device mandate that has gone before Congress on several occasions but has not been successful in passing into law.
Nevertheless, there have been 27 states that have passed there on version of EPICC since 1998 (Andrews, 2010). However, requirements for coverage vary from state to state and self-funded insurance plans are exempt from complying. Throughout the last decade there have been several lawsuits filed against employers unwilling to include prescription contraception benefits. The first such case was Erickson versus Bartell. In 2001, Jennifer Erickson brought a lawsuit of sexual discrimination against Bartell Drug Company for failing to provide birth control in a prescription drug benefit package.
Federal Judge Lasnik determined that Bartell Drug Company was in violation of Title VII and the PDA (HRMagazine, 2005). Sadly, the majority of employers who exclude prescription contraceptives choose to wait for legal action before changing policy. In those cases, society loses as precious taxpayer dollars are spent. Employer Expenses Many people have the misconception that it is expensive for an employer to provided prescription contraceptive benefits and that the employer should be able to limit available benefits to help keep health insurance premiums to a minimum.
A study conducted by the Washington Business Group on Health concluded that employers experience greater direct and indirect financial losses when an employee becomes pregnant. The indirect expenses include the employee’s absence for doctor’s appointments, fatigue, or illness. Indirect costs can also include reduced productivity, and the need to train another person to fulfill the pregnant employee’s position when absent. Direct costs can reach well above $10,000 for expenses related to pre-natal care, delivery, and one-year of infant pediatrics (HRMagazine, 2005).