After four years of setbacks, abortion-rights lawmakers set their sights this year on a goal that they hope will prove less controversial than abortion--family planning.
Their focus is narrow: to require that all health insurance plans for federal employees cover contraception on the same basis that they insure other prescription drugs.
Nevertheless, their campaign is expected to result in a pitched battle today when the House debates the annual spending bill that includes funds for the Federal Employees Health Benefit Plan.
The outcome will reach far beyond the 3 million-plus federal workers. Like other large employers, the federal government sets minimum coverage requirements for insurers that wish to cover any of its workers. Because the federal employees' health plan is the largest employer-based plan in the nation, its policies often influence standards for private employer plans.
The provision to be debated by the House would require that any plan providing prescription drug coverage would have to cover the five major forms of contraception: birth control pills, intrauterine devices, diaphragms, Norplant and the injectable contraceptive, Depo-Provera.
Of the health plans that cover federal employees, 81% do not cover all five methods of contraception. For example, Blue Cross/Blue Shield, which has the most enrollees, covers all but the diaphragm.
And in private employer health plans, contraceptive coverage is now spotty, according to surveys by the Alan Guttmacher Institute, a nonprofit organization that focuses on sexual- and reproductive-rights issues. Although more than 80% of health maintenance organizations cover the cost of birth control pills, diaphragms and Depo-Provera, fewer than 40% of fee-for-service health plans and open network plans such as preferred provider organizations offer such coverage.
The provision on the House floor cleared the Appropriations Committee by just two votes last week but only after a handful of moderate Republicans joined Democrats to support it.
"This is not pro-choice. This is not pro-life. It's not Democrat. It's not Republican," said Rep. Nita M. Lowey (D-N.Y.), who sponsored the provision.
If Lowey and others prevail on the House floor, they will press to extend the requirement to all private insurance plans. A separate bill on that issue has been introduced in both the House and the Senate.
Mandated coverage of birth control wins strong public approval ratings, especially from women. In a recent poll by the Kaiser Family Foundation, more than 70% of respondents supported insurance coverage of family planning methods, even if the cost of monthly insurance premiums was higher.
"It's basic health care for women," Lowey said, noting that her search for a way to support women's reproductive health has repeatedly run into locked-arm opposition from the largely anti-abortion Congress.
Republicans who support family planning but oppose abortion say that this is one of the few proposals that they can support because it is targeted solely at preventing unwanted pregnancies.
"We should do as much as possible to encourage people to control the number and spacing of their children," said Rep. John Edward Porter (R-Ill.), who opposes proposals to fund abortion coverage.
"Family planning is sometimes confused with abortion, but I think that there are people who say they are anti-abortion who are really anti-family planning, and this will flush them out," Porter said.
Opponents of abortion are attacking this measure primarily because they oppose Depo-Provera and some birth control pills, which they say can interrupt the implantation of a fertilized egg in the uterus and is therefore equivalent to an early abortion.
"As far as we're concerned, once the egg is fertilized it is an individual member of the human family," said Douglas Johnson of National Right to Life.
The organization would like the measure to be altered to say that only methods that prevent fertilization could be covered. Rep. Tom A. Coburn (R-Okla.) plans to offer an amendment that would preclude any form of birth control that would interfere with the implantation of an embryo in the uterus.
There is also opposition from the politically powerful National Conference of Catholic Bishops, according to proponents of the measure. Health plans run by Catholic groups would have to stop serving federal workers if they were required to cover contraception, which they regard as counter to God's will.
Opposition from anti-abortion groups is particularly potent in an election year, since such groups are expected to play a crucial role in Republican efforts to keep their majority in Congress.
Lowey pointed out that her provision is designed to prevent unwanted pregnancies and thus would cut back on abortions. Furthermore, the main proponent of the measure is the American College of Obstetricians and Gynecologists, not abortion rights groups.
"The tragedy is that this is occurring in this country, where we have an array of really safe methods, but they are not available to all women," said Anita Nelson, an obstetrician-gynecologist at UCLA.
Nelson said that, because of lack of coverage, some of the most effective forms of contraception such as birth control pills costing about $25 a month are beyond the reach of many women.