Among states, Colorado lags in providing for reproductive care

A new bill that would mandate Colorado insurance companies to cover birth control and maternity care is aimed at addressing the conditions that place Colorado among the worst states in the nation when it comes to providing for reproductive health.

pregnant tummy

Colorado’s low-rating comes courtesy of a 2006 nonprofit Guttmacher Institute report, which ranked Colorado 40th in access to birth control. By contrast, Alabama–hardly considered a progressive state–ranked 4th.

Colorado, like all states, is subject to federal mandates that require employer-based health plans for companies larger than 15 to cover birth control and maternity. But Colorado has no coverage mandates for maternity or birth control on the remaining markets. The situation has led to significant gaps in maternity and contraceptive coverage for Colorado women– particularly women buying plans on the individual market.

The Colorado Independent investigated individual-market options in the state and found a tangle of plans women and families might cobble together that even the insurance agents paid to sell them couldn’t recommend. The options were expensive; the coverage was undependable.

On the issue of birth control, The Colorado Independent questioned the nine companies who offer coverage on the individual market through ehealthinsurance.com. Three companies said they offer birth control coverage on most of their plans; three don’t at all; one covers birth control devices, but not their implantation; one covers birth control for plans that include brand-name drugs (an option which requires the purchase of a rider for all the plans for sale at ehealthinsurance.com) — and one company still has not yet responded to inquiries. Moreover, whether a plan covers birth control is not always readily available information: it’s generally buried in the “exclusions and limitations” section.

But Rep. K. Jerry Frangas, a Democrat from Denver, recently proposed a bill that would force insurance companies to cover both maternity and birth control across all markets.

Whether or not the bill will pass remains to be seen. But if it did, passage would hardly earn Colorado a “pioneer” ranking. Many other states have already mandated insurance companies to cover birth control, and a number have full or partial maternity mandates, as well.

Birth control

Twenty-five states already have contraceptive mandates, according to a 2007 National Women’s Law Center (NWLC) study.  In general, those mandates require health insurance companies that cover prescription drugs to also cover any any prescription contraceptive drug or device that has been approved by the United States Food and Drug Administration

Nearly all of the laws were passed by the state legislature—except in Washington State, where the Insurance Commissioner issued an administrative rule mandating contraceptive equity.

The  NWLC argues that the exclusion of prescription contraceptives from health insurance coverage unfairly disadvantages women by singling out a health insurance need that only they have and giving it unfavorable treatment–requiring women to spend more of their income on this out-of-pocket cost.

But access to contraception is also critical in preventing unintended pregnancies—and enabling women to control the timing and spacing of their pregnancies, notes the report. This, in turn, reduces the incidence of maternal death, low birth weight babies, and infant mortality.

Maternity

A 2008 National Women’s Law Center study found that 21 states have an additional benefit mandate that relates to maternity care, some of which provide more access to maternity care than others.

For example, in New York, only HMOs and nonprofit insurance companies are required to cover maternity, leaving what Brigette Courtot, senior policy analyst with the National Women’s Law Center, called “a very small proportion” of plans without maternity. On the other hand, Maine and New Hampshire have mandates that require insurance companies to offer one or more plans that cover maternity. But such plans, according to the 2008 report, can come at a high and unaffordable cost.

According to Courtot,  five states mandate insurance companies to cover maternity across all markets: Massachusetts, Montana, New Jersey, Oregon, and Washington.

Courtot pointed out that it wouldn’t be accurate to suggest that a maternity mandate wouldn’t raise premiums. But she argued that the rise wouldn’t be as great as everyone fears–and that it would be outweighed by tremendous cost savings for women currently paying for pregnancy out-of-pocket.

For example, in 2008, noted Courtot, the California Health Benefits Review Program, which provides independent analysis of the impacts of proposed mandates, analyzed a bill that would have mandated maternity coverage in 40 percent of California’s individual market. (The other 60 percent of the market is already subject to a maternity mandate.)

The program estimated that the average health expenditure increase for all policyholder would be .32 percent.

“The cost issue is overblown,” said Courtot. “Most mandates raise premiums by less than 1 percent.”

Furthermore, she noted, when insurance companies don’t cover maternity, that cost is often picked up by state-sponsored aid.

According to Chaer Robert, a board member at the Women’s Lobby of Colorado, over one-third of the babies born in Colorado are born on public assistance. In an earlier interview, Robert speculated that the number might be lower if Colorado women had better access to maternity coverage through the insurance market.

“Whether it’s the state creating a special state-only program or if the fact that these plans don’t include maternity means that women are more likely to get covered through Medicaid, it is true that states are already covering a good portion of care that women are receiving,” said Courtot.

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