[Congressional Record Volume 145, Number 82 (Thursday, June 10, 1999)]
[Senate]
[Pages S6857-S6859]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Mr. Reid, Mr. Warner, Mr. Torricelli, 
        Mr. Jeffords, Mr. Moynihan, Mr. Chafee, Ms. Milulski, Mr. Smith 
        of Oregon, Mrs. Boxer, Mr. Specter, Mr. Durbin, Mrs. Murray, 
        Mr. Kerrey, Mr. Robb, Mr. Schumer, Mr. Johnson, Mr. Lautenberg, 
        Mr. Cleland, Mr. Leahy, Mr. Harkin, Mr. Dodd, Mr. Kennedy, Mr. 
        Daschle, Mrs. Feinstein, Mrs. Lincoln, Mr. Inouye, Mr. Akaka, 
        Mr. Bayh, Mr. Lieberman, Mr. Wellstone, and Mr. Bryan):
  S. 1200. A bill to require equitable coverage of prescription 
contraceptive drugs and devices, and contraceptive

[[Page S6858]]

services under health plans; to the Committee on Health, Education, 
Labor, and Pensions.


    Equity in Prescription Insurance and Contraceptive Coverage Act

 Ms. SNOWE. Mr. President, I rise today with my colleague from 
Nevada, Senator Harry Reid, to reintroduce the Equity in Prescription 
Insurance and Contraceptive Coverage Act. We are back today, with the 
support of 30 Members of the Senate, to finish the work we began in the 
last Congress.
  Why are we back again this year? Because the need behind the Equity 
in Prescription Insurance and Contraceptive Coverage Act has not 
abated. There are three million unintended pregnancies every year--half 
of all pregnancies that occur every year in this country. And 
frighteningly, approximately half of all unintended pregnancies end in 
abortion.
  I am firmly pro-choice and I believe in a woman's right to a safe and 
legal abortion when she needs this procedure. But I want abortion to be 
an option that a woman rarely needs. So how do we prevent this? How do 
we reduce the number of unintended pregnancies?
  The safest and most effective means of preventing unintended 
pregnancies are with prescription contraceptives. And while the vast 
majority of insurers cover prescription drugs, they treat prescription 
contraceptives very differently. In fact, half of large group plans 
exclude coverage of contraceptives. And only one-third cover oral 
contraceptives--the most popular form of reversible birth control.
  When one realizes the insurance ``carve-out'' for these prescriptions 
and related outpatient treatments, it is no longer a mystery why women 
spend 68 percent more than men in out-of-pocket health care costs. No 
woman should have to forgo or rely on inexpensive and less effective 
contraceptives for purely economic reasons, knowing that she risks an 
unintended pregnancy.
  In last year's Omnibus Appropriations Bill, Congress instructed the 
health plans participating in the Federal Employees Health Benefit 
Plan--the largest employer-sponsored health insurance plan in the 
world--to provide prescription contraceptive coverage if they cover 
prescription drugs as a part of their benefits package. The protections 
we afford to Members of Congress, their staff, other federal employees 
and annuitants, and to the approximately two million women of 
reproductive age who are participating in FEHBP need to be extended to 
the rest of the country.
  Unfortunately, the lack of contraceptive coverage in health insurance 
is not news to most women. Countless American women have been shocked 
to learn that their insurance does not cover contraceptives, one of 
their most basic health care needs, even though other prescription 
drugs which are equally valuable to their lives are routinely covered. 
Less than half--49 percent --of all large-group health care plans cover 
any contraceptive method at all and only 15 percent cover the five most 
common reversible birth control methods. HMOs are more likely to cover 
contraceptives, but only 39 percent cover all five reversible methods. 
And ironically, 86 percent of large group plans, preferred provider 
organizations, and HMOs cover sterilization and between 66 and 70 
percent of these different plans do cover abortion.
  The concept underlying EPICC is simple. This legislation says that if 
insurers cover prescription drugs and devices, they must also cover 
FDA-approved prescription contraceptives. And in conjunction with this, 
EPICC requires health plans which already cover basic health care 
services to also cover outpatient services related to prescription 
contraceptives.
  The bill does not require insurance companies to cover prescription 
drugs. What the bill does say is that if insurers cover prescription 
drugs, they cannot carve prescription contraceptives out of their 
formularies. And it says that insurers which cover outpatient health 
care services cannot limit or exclude coverage of the medical and 
counseling services necessary for effective contraceptive use.
  This bill is good health policy. By helping families to adequately 
space their pregnancies, contraceptives contribute to healthy 
pregnancies and healthy births, reduce rates of maternal complications, 
and reduces the possibility of low-birthweight births.
  Furthermore, the Equity in Prescription Insurance and Contraceptive 
Coverage Act makes good economic sense. We know that contraceptives are 
cost-effective: in the public sector, for every dollar invested in 
family planning, $4 to $14 is saved in health care and related costs. 
And all methods of reversible contraceptives are cost-effective when 
compared to the cost of unintended pregnancy. A sexually active woman 
who uses no contraception costs the health care provider an average of 
$3,225 in a given year. The average cost of an uncomplicated vaginal 
delivery in 1993 was approximately $6,400. And for every 100 women who 
do not use contraceptives in a given year, 85 percent will become 
pregnant.
  Why do insurance companies exclude prescription contraceptive 
coverage from their list of covered benefits--especially when they 
cover other prescription drugs? The tendency of insurance plans to 
cover sterilization and abortion reflects, in part, their long-standing 
tendency to cover surgery and treatment over prevention. Sterilization 
and abortion is also cheaper. But insurers do not feel compelled to 
cover prescription contraceptives because they know that most women who 
lack contraceptive coverage will simply pay for them out of pocket. And 
in order to prevent an unintended pregnancy, a woman needs to be on 
some form of birth control for almost 30 years of her life.
  The Equity in Prescription Insurance and Contraceptive Coverage Act 
tells insurance companies that we can no longer tolerate policies that 
disadvantage women and disadvantage our nation. When our bill is 
passed, women will finally be assured of equity in prescription drug 
coverage and health care services. And America's unacceptably high 
rates of unintended pregnancies and abortions will be reduced in the 
process.
  The philosophy behind the bill is that contraceptives should be 
treated no differently than any other prescription drug or device. It 
does not give contraceptives any type of special insurance coverage, 
but instead seeks to achieve equity of treatment and parity of 
coverage. For that reason, the bill specifies that if a plan imposes a 
deductible or cost-sharing requirement on prescription drugs or 
devices, it can impose the same deductible or cost-sharing requirement 
on prescription contraception. But it cannot charge a higher cost-
sharing requirement or deductible on contraceptives. Outpatient 
contraceptive services must also be treated similarly to general 
outpatient health care services.
  Time and time again Americans have expressed the desire for their 
leaders to come together to work on the problems that face us. This 
bill exemplifies that spirit of cooperation. It crosses some very wide 
gulfs and makes some very meaningful changes in policy that will 
benefit countless Americans.
  As someone who is pro-choice, I firmly believe that abortions should 
be safe, legal, and rare. Through this bill, I invite both my pro-
choice and pro-life colleagues to join with me in emphasizing the 
rare.
  Mr. REID. Mr. President, I am proud to introduce today, with Senator 
Snowe, the Equity in Prescription and Contraception Coverage Act of 
1999. Senator Snowe and I first introduced this bill in 1997.
  The legislation we introduce today would require insurers, HMO's and 
employee health benefit plans that offer prescription drug benefits to 
cover contraceptive drugs and devices approved by the FDA. Further, it 
would require these insurers to cover outpatient contraceptive services 
if a plan covers other outpatient services. Lastly, it would prohibit 
the imposition of copays and deductibles for prescription 
contraceptives or outpatient services that are greater than those for 
other prescription drugs.
  I hope that we have the success this year that we had last year in 
directing the Federal Health Benefit Plans to cover contraception. As 
many of you recall, after a tough fight, Congresswoman Lowey and I were 
able to amend the Treasury Postal Appropriations bill so that Federal 
Health Plans must cover FDA approved contraceptives.
  EPICC is about equality for women, healthy mothers and babies, and 
reducing the number of abortions that are

[[Page S6859]]

performed in this country each year. For all the advances women have 
made, they still earn 74 cents for every dollar a man makes and on top 
of that, they pay 68 percent more in out of pocket costs for health 
care than men. Reproductive health care services account for much of 
this 68 percent difference. You can be sure, if men had to pay for 
contraceptive drugs and devices, the insurance industry would cover 
them.
  The health industry has done a poor job of responding to women's 
health needs. According to a study done by the Alan Guttmacher 
Institute, 49 percent of all large-group health care plans do not 
routinely cover any contraceptive method at all, and only 15 percent 
cover all five of the most common contraceptive methods.
  Women are forced to use disposable income to pay for family planning 
services not covered by their health insurance--``the pill'' one of the 
most common birth control methods, can cost over $300 a year. Women who 
lack disposable income are forced to use less reliable methods of 
contraception and risk an unintended pregnancy.
  If our bill was only about equality in health care coverage between 
men and women, that would be reason enough to pass it. But our 
legislation also provides the means to reduce abortions, and have 
healthier mothers and babies. Each year approximately 3 million 
pregnancies, or 50 percent of all pregnancies, in this country are 
unintended. Of these unintended pregnancies, about half end in 
abortion.
  Reliable family planning methods must be made available if we wish to 
reduce this disturbing number.
  Ironically, abortion is routinely covered by 66 percent of indemnity 
plans, 67 percent of preferred provider organizations, and 70 percent 
of HMO's. Sterilization and tubal ligation are also routinely covered. 
It does not make sense financially for insurance companies to cover 
these more expensive services, rather than contraception. But insurance 
companies know that women will bear the costs of contraception 
themselves--and if they can not afford their method of choice, there 
are always less expensive means to turn to. Of course less expensive 
also means less reliable.
  This just seems like bad business to me. If a woman can not afford 
effective contraception, and she turns to a less effective method and 
gets pregnant, that pregnancy will cost the insurance company much more 
than it would cost them to prevent it. According to one recent study in 
the American Journal of Public Health, by increasing the number of 
women who use oral contraceptives by 15 percent, health plans would 
accrue enough savings in pregnancy care costs to cover oral 
contraceptives for all users under the plan. Studies indicate that for 
every dollar of public funds invested in family planning, four to 
fourteen dollars of public funds is saved in pregnancy and health care-
related costs. Not only will a reduction in unintended pregnancies 
reduce abortion rates, it will also lead to a reduction in low-birth 
weight, infant mortality and maternal morbidity.
  Low birth weight refers to babies who weigh less than 5.5 pounds at 
birth. How much a baby weighs at birth is directly related to the 
baby's survival, health and development. In Nevada, during the past 
decade, the percent of low birth weight babies has increased by 7 
percent. These figures are important because women who use 
contraception and plan for the birth of their baby are more likely to 
get prenatal care and lead a healthier life style. The infant mortality 
rate measures the number of babies who die during their first year of 
life. In Nevada, between the years of 1995 and 1997, the infant 
mortality rate was 5.9, this means that of the 77,871 babies born 
during this period, 459 infants died before they reached their first 
birthday. The National Commission to Prevent Infant Mortality 
determined that ``infant mortality could be reduced by 10 percent if 
all women not desiring pregnancy used contraception.''
  It is vitally important to the health of our country that quality 
contraception is not beyond the financial reach of women. Providing 
access to contraception will bring down the unintended pregnancy rate, 
insure good reproductive health for women, and reduce the number of 
abortions. It is a significant step, in my opinion, to have support 
from both pro-life and pro-choice Senators for this bill. Prevention is 
the common ground on which we can all stand. Let's begin to attack the 
problem of unintended pregnancies at its root.
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