News Contraception

The Hawaii Compromise? White House to Announce Change In Birth Control Mandate

Jodi Jacobson

This morning, news reports indicate an announcement may be imminent from President Obama on a "compromise" on the birth control mandate. To recap, the mandate requires that all employer-based health insurance offer coverage without a co-pay of all FDA-approved contraceptive methods.

See all our coverage of the 2012 Contraceptive Mandate here.

This morning, news reports indicate an announcement may be imminent from President Obama on a “compromise” on the birth control mandate. To recap, the mandate requires that all employer-based health insurance offer coverage without a co-pay of all FDA-approved contraceptive methods. The basis for this mandate is a mountain of public health and individual medical evidence supporting the benefits of access to contraception as well as another mountain of legal precedent, at the base of which sits the basic human rights of all people to determine whether, when, and with whom to bear children.

Under the current rule, which goes into effect officially on August 1, 2012, churches and other institutions whose primary purpose is the inculcation of religious beliefs are exempt. Religiously-affiliated hospitals, universities and social service organizations whose primary purpose are medicine, education, or services and who employ people of many faiths are not.

This rule has thrown the United States Conference of Catholic Bishops into a tizzy the likes of which have not been seen since… oh yeah… 2010 and the health reform debate when they made insisted that women lose all coverage for abortion care they now have, and when they tried to remove contraception from the primary health care benefits package.  The Bishops not only want religiously-affiliated institutions to be exempt no matter what their purpose; they’ve now made clear they want individual employers to be able to exempt themselves based on their “conscience.”

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Now, the Obama Administration, having completely fumbled an issue they have repeatedly fumbled and from which experiences they have apparently not learned a thing, is purported to be on the verge of announcing a “compromise.”

Early reports are that such a compromise may at least to some degree be based on a law in Hawaii. 

In 1999 Hawaii passed a law (which went into effect in 2000), that says as follows:

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)

And the problem here, especially in this climate is as I said yesterday. It legitimizes a false argument about religious freedom that now will be used again and again to limit reproductive rights. It separates out a form of basic primary preventive care as though it were not basic primary preventive care, and it re-stigmatizes contraception. It gives Church administrators power over women that they have shown time and again to abuse and puts women in a subservient position to administrators at their place of work.  And it requires individual women to ensure accountabiity to vague laws and statutes, creating a nightmare for them.  It gives more power to people who are spending their entire lives working to take reproductive health care away from women.

Sarah Posner, cited at FiredogLake, quote Jon O’Brien of Catholics for Choice as follows:

“It may seem reasonable on the surface,” said O’Brien, “but it sends the wrong message, namely: that an employer’s personal beliefs may interfere with an employee’s conscience and therefore make it more difficult for him/her to access the healthcare coverage that he or she needs.”

In New York, which allows for this “self-insurance,” O’Brien said, “we have heard horror stories” of how it operates in practice. Imagine, he said, working at a Catholic school and going to your employer to request this special coverage. “We’ve heard anecdotal evidence that some workers at certain religious institutions have had to sign testimonials stating that they understand that contraception is against their employers’ beliefs, thereby bullying them into either not seeking insurance that covers contraception or into jumping through hoops to try to access it,” O’Brien said.

Finally, a national law will ostensibly over-ride state laws, many of which right now in fact require universal coverage of contraception in their plans with the exception only of institutions for which religious inculcation is their primary purpose.  This means that untold numbers of women will lose coverage they already have.

Compromise? For whom on behalf of whom?

News Contraception

New Hawaii Law Requires Insurers to Cover a Year’s Supply of Birth Control

Nicole Knight Shine

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills.

Private and public health insurance must cover up to a year’s supply of birth control under a new Hawaii law that advocates called the nation’s “strongest.”

The measuresigned by state Gov. David Ige (D) on Tuesday, applies to all FDA-approved contraceptive medications and devices.

Hawaii joins Washington, D.C., which also requires public and private insurers to cover up to 12 months of birth control at a time.

Oregon passed a similar measure in 2015, but that law requires patients to obtain an initial three-month supply of contraception before individuals can receive the full 12-month supply—which the Hawaii policy does not.

“At a time when politicians nationwide are chipping away at reproductive health care access, Hawaii is bucking the trend and setting a confident example of what states can do to actually improve access,” Laurie Field, Hawaii legislative director for Planned Parenthood Votes Northwest and Hawaii, said in a statement.

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills. Both the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Centers for Disease Control and Prevention recommend supplying up to one year of oral contraceptives at a time, as the Hawaii Senate Committee on Commerce, Consumer Protection, and Health noted in a 2016 conference report.

Fifty-sex percent of pregnancies in Hawaii are unintended, compared to the national average of 45 percent, according to figures from the Guttmacher Institute.

Women who received a year’s supply of birth control were about a third less likely to experience an unplanned pregnancy and were 46 percent less likely to have an abortion, compared to those receiving a one- or three-month supply, according to a 2011 study of 84,401 California women published in Obstetrics and Gynecology.

Reproductive rights advocates had championed the legislation, which was also backed by ACOG–Hawaii Section, the Hawaii Medical Association, and the Hawaii Public Health Association, among other medical groups.

“Everyone deserves affordable and accessible birth control that works for us, regardless of income or type of insurance,” Planned Parenthood’s Field said in her statement.

News Contraception

Maryland Moves to the Forefront in Birth Control Access

Michelle D. Anderson

It aims to prevent insurers, nonprofit health service plans, and health maintenance organizations from requiring "a copayment, coinsurance, or prior authorization requirement" for most contraceptive drugs and services.

Maryland Gov. Larry Hogan (R) this week signed what reproductive rights advocates are calling the nation’s most sweeping and comprehensive birth control access law.

Called the Maryland Contraceptive Equity Act, HB 1005 will require insurance plans regulated by the state to offer birth control with no out-of-pocket costs, starting in January 2018.

First introduced in February, the law was one of 196 bills Hogan signed on Tuesday. It aims to prevent insurers, nonprofit health service plans, and health maintenance organizations from requiring “a copayment, coinsurance, or prior authorization requirement” for most contraceptive drugs and services.

Sponsored by Del. Ariana B. Kelly (D-Montgomery) and state Sen. Delores Kelley (D-Baltimore County), the law requires companies to provide vasectomy coverage and six months of contraception coverage at a time. It also prohibits pre-authorizations for long-acting reversible contraception methods, such as intrauterine devices.

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Maryland is now the first state to require insurers to cover over-the-counter contraceptive medications, including newer options like Plan B.

Lawmakers said the law won’t go into effect until 2018 so insurers can prepare for the 2017 open-enrollment season, the Baltimore Sun reported.

Champions of the bill, such as local Planned Parenthood officials, have noted that Maryland has a history of being at the forefront of reproductive health care, telling the Sun that the state first mandated contraceptive coverage in 1998.

Karen Nelson, president and CEO of Planned Parenthood of Maryland, called the law a “bold move” and praised the Democratic-led legislature for passing the bill.

The state’s Planned Parenthood affiliate said in a statement that the law would make Maryland the first to provide equity in contraception access for men by requiring coverage of vasectomies without co-payments.

Prior to Hogan’s signing, other states have been “implementing piecemeal provisions” rather than comprehensive laws that expand birth control access, Nelson said.

Del. Ariana B. Kelly told the Sun that the law would fill in “gaps” left by the Affordable Care Act, which only requires insurers to offer one of 18 categories of contraceptives with no co-payment. That means some people may have to pay up front for their preferred method of birth control if their insurer does not cover it.