Why insurers oppose a fantastic proposal to let California women have a year’s supply of birth control
On Monday, the California Senate is expected to approve a bill that would allow women to pick up a year’s worth of birth control pills at a time, instead of forcing them, as their health insurance companies so often do, to return to the pharmacy every month or every three months for refills.
A year’s supply of contraception, studies show, reduces unwanted pregnancies, lowers the abortion rate and saves millions of dollars.
“There is a need for consistent, uninterrupted contraception,” said the bill’s author, Democratic state Sen. Fran Pavley, when she introduced the measure, SB 999, at a committee hearing last week. It’s especially important, she said, for women who live in rural areas, or whose busy schedules make it difficult to get to the pharmacy to keep refilling a prescription. “It’s a bill whose time has come.”
I’ll get to why in a moment, but first it’s important to understand why this modest proposal could have such a major impact.
To get a handle on the issue, UC San Francisco researchers analyzed the birth control supplies and pregnancy rates among 84,401 California women. The study was conducted in 2011 based on data from 2006. Eleven percent of the women got a one-year supply of birth control, 58% got a three-month supply, and 20% got a one-month supply. Women who received only a 30-day or 90-day supply of contraception had a much higher rate of unintended pregnancy than women who took home a year’s supply at a time.
Why is that? Because women work. They go to school. They don’t always plan things meticulously. If you are busy, or if you live in a rural community, refilling a birth control prescription can be a burden.
“Every time you have to stop and pick up your pills, that’s life getting in the way,” said Deborah Rotenberg, legal counsel for Planned Parenthood Affiliates of California, a cosponsor of the bill.
Yet, unlike blood pressure or cholesterol-lowering meds, where missing a day’s dose will not hurt you, missing a day or two of birth control pills can result in instant fertility — and an unwanted pregnancy.
Diana Greene Foster, the lead author of the UC San Francisco study, told the UCSF News Service that providing only a month’s worth of oral contraceptives at a time to women is “similar to asking people to visit a clinic or pharmacy to renew their seat belts each month.”
A separate analysis by the California Health Benefits Review Program, which was created in 2002 to provide the Legislature with independent analyses of proposed health insurance mandates, found that fewer office visits and fewer unintended pregnancies would result in a savings of about $42.8 million a year. It also estimated a decrease of 15,000 unintended pregnancies per year (resulting in 6,000 fewer live births, 2,000 fewer miscarriages and 7,000 fewer abortions).
“These kinds of results — from a research or medical standpoint — are just astounding,” Dr. Mitchell Creinin said when he testified last month at a state Senate hearing on the bill. Creinin is chief of family planning in the UC Davis Health System’s Department of Obstetrics and Gynecology. “A 12-month supply… decreases pregnancy rates and abortion substantially. This is a life-altering change.”
A 12-month supply decreases pregnancy rates and abortion substantially. This is a life-altering change.
— Dr. Mitchell Creinin, UC Davis
By the way, doctors generally write 12-month prescriptions. It’s insurance companies that prevent women from receiving more than a 30- or 90-day supply, which is frustrating to physicians as well.
“We’re trying to remove barriers,” said Creinin, “and we know that removing barriers when a woman is trying to prevent unintended pregnancy is important.”
Health insurance industry opposition to this bill is a head-scratcher.
Steffanie Watkins of the Assn. of California Life and Health Insurance Companies sounded almost regretful when she told state senators last month that her group opposes the bill because women might get a year’s worth of pills and then not use them all. That just seems silly. Researchers found that a miniscule number of pills go unused. Anyway, compare the cost of a few wasted pills against the cost of prenatal care, plus labor and delivery. Or an abortion. It’s not even close.
A conversation I had with Nicole Evans of the California Assn. of Health Care Plans was more on point.
“We have a standard position on benefit mandates,” she told me. “They drive up the cost of coverage.”
But, but, but, I said, there are studies showing this measure could save millions of dollars a year! Evans had not seen them, she said, and they didn’t really matter, since the position of the industry is that mandates drive up costs. (Even if they don’t, I guess.)
“The bottom line is insurance companies don’t want to be told how to run their business,” said Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. “It’s a principle that’s near and dear to their heart.”
In 2013-2014, the California Health Benefits Review Program estimated, 744,000 California women between the ages of 15 and 44 were using hormone-based contraception like the pill, the patch or the vaginal ring. Only 5,000 women received a 12-month supply. If Pavley’s bill becomes law, that number could jump to 285,000.
To get a sense of how the law might affect a real person, I put in a call to my reliable, one-woman reproductive rights focus group. She’s a 23-year-old college graduate who works in a San Francisco medical clinic.
I told her about the proposal, which will need to be approved by the state Assembly and signed by the governor before it becomes law.
“Oh thank God!” my daughter, Chloe, practically shouted into my ear. “That was such a rude awakening for me — that you have to go to the pharmacy every month for your pills! It’s such a hassle! What if you can’t get your [act] together to go pick them up? That happened to my friend. She got pregnant and had to have an abortion.”
I have no idea why insurance companies are resisting a common sense proposal to make contraception less onerous for women. It’s a foolish kind of consistency that puts principles before the needs of real, live human beings.
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