[Congressional Record Volume 147, Number 7 (Monday, January 22, 2001)]
[Senate]
[Pages S373-S377]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Mr. Reid, Mr. Warner, Ms. Mikulski, 
        Mr. Jeffords, Mrs. Boxer, Mr. Specter, Mrs. Murray, Ms. 
        Collins, Mr. Johnson, Mr. Wellstone, Mr. Leahy, Mr. Kerry, Mr. 
        Durbin, Mr. Inouye, Mr. Akaka, Mr. Sarbanes, Mr. Schumer, Mr. 
        Harkin, Mrs. Clinton, and Mr. Corzine):
  S. 104. A bill to require equitable coverage of prescription 
contraceptive drugs and devices, and contraceptive services under 
health plans; to the Committee on Health, Education, Labor, and 
Pensions.


                 equitable coverage under health plans

  Mr. REID. Mr. President, I am proud to introduce today, with Senator 
Snowe, the Equity in Prescription and Contraception Coverage Act of 
2001 (EPICC).
  Our legislation would require insurers, HMOs 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.
  Our bill gives Americans on both sides of the abortion debate the 
opportunity to join together in the common goal of preventing 
unintended pregnancies. I am pleased that we have support from both 
pro-life and pro-choice Senators for this bill.
  We are introducing EPICC today--the first legislative day of the 
107th Congress--because equity in prescription contraception coverage 
is long overdue. Senator Snowe and I first introduced this bill in 
1997. Since this time, the Viagra pill went on the market, and one 
month later was covered by most indemnity policies. Birth control 
pills, which have been on the market since 1960, are covered by only 
thirty-three percent of insurance plans.
  Most recently, the U.S. Equal Employment Opportunity Commission 
(EEOC) issued a decision finding that an employer's failure to include 
insurance coverage for prescription contraceptives in an employee 
health benefits plan, when it covers other prescription drugs and 
devices, constitutes unlawful sex discrimination under Title VII of the 
Civil Rights Act of 1964.
  The EEOC ruling is an important step toward ensuring that women have 
access to affordable contraceptives. At the same time, it highlights 
the importance of our legislation because title VII applies only to 
employers; it does not cover insurance providers. An estimated 16 
million Americans obtain health insurance from private insurance other 
than employer-provided plans. Only the enactment of EPICC will ensure 
that contraceptive coverage is offered by insurance providers.
  Our efforts have not been entirely without results. For the past 
three consecutive years, we have passed a provision in the Treasury-
Postal Appropriations bill that requires Federal

[[Page S376]]

health plans to cover prescription contraceptives. It is time to pass 
EPICC and extend this law to all Americans.
  It is time to pass EPICC because EPICC is about equality for women. 
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.
  It is time to pass EPICC because 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.
  It is time to pass EPICC because 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.
  It is time to pass EPICC because insurance companies routinely cover 
more expensive services, including abortions, sterilizations and tubal 
ligations. Yet according to one study in the American Journal of Public 
Health, health plans would accrue enough savings in pregnancy care 
costs to cover oral contraceptives for all users under the plan by 
increasing the number of women who use oral contraceptives by 15 
percent. 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.
  It is time to pass EPICC because access to contraception will bring 
down the unintended pregnancy rate, ensure good reproductive health for 
women, and reduce the number of abortions. It is vitally important to 
the health of our country that quality contraception is not beyond the 
financial reach of women. Regardless of where you stand on the abortion 
issue, prevention is the common ground on which we can all stand. I 
urge you to join me in supporting EPICC.
  Ms. SNOWE. Mr. President, I rise today with my colleague form Nevada, 
Senator Harry Reid, to reintroduce the Equity in Prescription Insurance 
and Contraceptive Coverage Act.
  Today is the 28th anniversary of the landmark Roe v. Wade decision--
an anniversary which makes it especially poignant to reintroduce EPICC 
today. 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.
  The simplest and most effective means of reducing the number of 
abortions is to reduce the number of unintended pregnancies in America. 
And the safest and most effective means of preventing unintended 
pregnancies are with prescription contraceptives. Unfortunately, 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.
  For the last three years Congress has required the health plans 
participating in the Federal Employees Heath Benefit Program--the 
largest employer-sponsored health insurance plan in the country--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 and deserve to be extended to 
the rest of the country.
  Last December 13, the Equal Employment Opportunity Commission ruled 
that excluding contraceptives from health insurance plans is a 
violation of the 1978 Pregnancy Discrimination Act, which requires 
equal treatment of women ``affected by pregnancy, childbirth or related 
medical conditions,'' in all aspects of employment, including fringe 
benefits.
  The EEOC said that the Act also protects women against discrimination 
because they have the ability to become pregnant, not just because they 
are already pregnant. According to the EEOC's ruling, excluding 
contraceptives also amounts to sex discrimination because these 
prescriptions are available only for women. Furthermore, excluding 
contraceptives due to possible increased costs is not valid--under the 
Pregnancy Discrimination Act Congress specifically rejected costs as a 
defense.
  Unfortunately, the ruling only applies to the two cases examined by 
the EEOC and is not a general ``policy guidance'' that would apply to 
all employers. These two particular health plans must cover 
contraceptives, the ruling said, because they already cover a wide 
range of preventive services, including vaccinations, drugs to control 
blood pressure, weight loss medication and preventive dental care.
  Another health plan--one that doesn't cover these services--might not 
be in violation of the law. But most health plans cover similar 
services, and the decision announced in December could be used by other 
women who seek coverage from their employers.
  The Pregnancy Discrimination Act--and this EEOC decision--only 
reaches employers of 15 people or more. The Equity in Prescription 
Insurance Contraceptive Coverage Act reaches all insurance plans, no 
matter the size, and includes individual insurance--not just employer-
sponsored insurance plans.
  The time has come for Congress to act, once and for all, to ensure 
equity in prescription insurance coverage. The EEOC's decision provides 
a powerful impetus for action in Congress, and demonstrates the degree 
of concern through the nation about unfair and discriminatory 
prescription practices. The EEOC decision highlights the problem; I 
believe passage of our legislation in Congress is the solution.
  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.
  Thirteen states require their state-regulated health plans to 
coverage prescription contraceptive: Maryland, Connecticut, Georgia, 
Hawaii, New Hampshire, Nevada, North Carolina, Vermont, California, 
Delaware, Iowa, Rhode Island, and my home state of Maine. We need to 
ensure that this protection is expanded to all states.
  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.

[[Page S377]]

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 women 
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. 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 women needs to be on some from 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.
                                 ______