Missing in action at this year's legislature will be one stalwart champion of human rights and long-time supporter of nursing and health-care issues, Sen. Paula Julander. For eight years Julander sponsored, or helped find sponsorship for, a bill known in 2005 as Senate Bill 111, to prohibit gender discrimination in health care. This legislation, sometimes known as the "pill bill," sought to improve women's access to basic health care by addressing inequalities in prescription drug coverage.
In Utah, and nationwide, more than 65 percent of women of reproductive age practice contraception to plan and space their pregnancies. Even so, nearly half of all pregnancies in the United States are unintended at conception, and more than half of all unintended pregnancies end in abortion. Use of effective contraception is the key to preventing unintended pregnancies, and enhancing the health of women and children.
Cost plays a huge role in how, and if, women practice contraception. About three-fourths of reproductive-age American women are covered by some type of private health insurance, and 98 percent of these plans cover general prescription drugs. However, despite widespread use, and the proven safety, efficacy and cost-effectiveness of contraception, only 64 percent of employers cover oral contraceptives, and only 41 percent cover all five of the leading FDA-approved reversible contracept -ives.
This failure is costly, not only for insurers, who may have to pay costs for either abortion or maternity care, but for families who may be physically or financially unable to withstand an unintended pregnancy. During their childbearing years, women spend 68 percent more on out-of-pocket health care costs than their male counterparts, with reproductive care and contraception accounting for most of the difference.
Inequity in prescriptive coverage for women was already a concern when drugs for erectile dysfunction entered the U.S. market in 1998. Within months of the introduction of Viagra, more than half of the prescriptions written for the drug were covered by insurance.
Contraceptive coverage was required in the Federal Employees Health Benefit Plan in 1999, so employees in institutions which receive federal funding have full coverage. In December 2000, the U.S. Equal Employment Opportunity Commission found that failure of employers to include contraceptives in prescription drug coverage, when other prescription drugs are covered, constitutes sex discrimination under Title VII.
The result is that employers with 15 or more employees cannot exclude contraceptives from a health plan that covers other prescription drugs without risking discrimination litigation.
Opponents of gender equity in prescription coverage argue that including this coverage would impose a financial burden on insurers and employers. A 1998 study by the Alan Guttmacher Institute found that adding coverage for a full range of contraceptive options would increase costs by an average of $12.40 per employee per year, a premium increase of about 0.6 percent. This same study concluded that the cost of covering unintended pregnancy was much higher than the cost of providing contraceptive cover -age.
In 2005, Senate Bill 111 was rejected by the Health and Human Services Committee - and thus was not brought before the Senate for a full vote - because two legislators did not want to be seen as supporting birth control.
This legislation would not endorse, provide or offer funding for abortion services or emergency contraception. Its sole mandate is to direct employers who already offer health-care coverage that includes prescription drug coverage to offer, in accordance with federal guidelines, and with an eye to preventing litigation regarding sex discrimination, a plan that includes coverage of the five contraception methods.
Contraception plays a large role in improving the lives and health of women and children. And that is why Utah lawmakers should pass this legislation.
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Melody Krahulec is a registered nurse at University Hospital and currently working on a master's degree in nursing education.
