Still No Pill Bill

Birth Control Coverage Snagged as Legislators Fight Over Cancer Screenings

If you're a woman living in New York and you're on the pill, you've probably forked out upwards of $1400 since the legislature first started talking about a law that would have forced your insurance company to pay for birth control. Perhaps you'd rather have spent that money on round-trip air fare for two to China. Or on a Prada bag. And shoes. Or, as the people from Feed the Children will tell you, that money could have paid for 15 years' worth of food for a child in Afghanistan. Women pay 68 percent more than men for out-of-pocket health expenses--the kind of outrage that Maryland Senator Barbara Mikulski has referred to as the "gender tax." But that doesn't seem to bother the men who've been sitting on "pill bill" legislation for four years.

On Monday, the State Assembly came out with a new version of the Women's Health and Wellness Act that, on some points, is close to the bill the Senate passed in February. Because both versions would require insurance companies that cover medications to also pay for all FDA-approved forms of birth control, some women's health advocates are already declaring victory. "Everyone's abuzz about the legislation up here," Joann Smith, director of Family Planning Advocates, reports excitedly from the capitol. Last week, the Albany Times Union announced, "Health measure impasse broken" on its front page.

But the pill bill, which has inspired fleeting moments of optimism before, is far from a done deal. And not for the reasons you might think. Not, for example, because of the Catholic Church's all-out assault. In a March 1 letter addressed to "friends of the Lord," Cardinal Edward Egan urged Catholics to protest the bill, which he called "outrageous," "anti-Catholic," and "a direct attack on our faith." A few weeks ago, right before the sexual abuse scandal exploded, the Cardinal even made a special trip to Albany in which he asked the Senate to revote on the measure.

In fact, though, this time the Church is just a paper tiger. The Senate's bill spares the church the delicate situation it would face as an employer. Using language that stood up to legal challenges in California, the Senate exempts the Church, and possibly Catholic colleges and hospitals, from having to cover birth control for their workers. The Assembly, which had rejected such a "conscience clause" in the past, has adopted the Senate's language in its latest version.

So what's the problem? Ironically, another women's health issue: breast and cervical exams, which were added to the pill bill in an effort to sugar-coat the politically sensitive issue of contraception. Aware that the Republican-dominated Senate had historically put the Archdiocese's interests over women's, advocates decided to lump contraceptive coverage together with theoretically noncontroversial requirements that insurers pay for screening for osteoporosis and breast and cervical cancer.

But now, some say, the Senate is balking on those heath mandates by pushing for loopholes that might let copayments and deductibles get in the way of screening for these major killers and would allow HMOs to decide case-by-case whether they will pay for mammograms. "The only argument for the Senate version is to protect the insurance companies," says Richard Gottfried, chair of the Assembly's health committee, who says the differences between the two versions are potential deal-breakers. "You're either on the side of women's health or on the side of insurance companies. The insurance industry either wrote that bill or it's an astonishing coincidence that it's entirely consistent with their agenda."

And while the entire bill is hung up on this money matter, the story of greed has gotten lost amidst the news that the Senate had finally moved forward on birth control. "It's easier for (the Senate) to have everybody looking at the contraceptive piece of this bill and the notion of the very active Catholic Church opposition," says Deborah Glick, Manhattan assembly member and the Women's Health bill's lead sponsor. "Contraception is just a smoke screen for not dealing with what I believe is a harder issue--the financial barriers that women have when it comes to accessing time-sensitive cancer screening. They like everybody making a big fuss over how they moved from the 14th century to the 18th century."

Indeed, having birth control paid for like every other prescription drug and medical service is hardly a radical notion anymore. More than a third of states--including such traditionally conservative ones as North Carolina and Missouri--have already adopted pill bills. Though national legislation (which had an encouraging hearing in the Senate on September 10) has taken a back seat to anti-terrorism and military issues in Washington, the federal government has been required to provide contraceptive coverage to its employees since 1999. And, five years before that, the Equal Employment Opportunity Commission decided that an employer's failure to include birth control in its prescription drug plan amounted to gender discrimination.

Even the Church must know it's fighting an uphill battle. Though official Catholic doctrine still holds that using birth control is a sin even for married couples, fully 96 percent of Catholic women who have ever had sex report having used birth control. So why is the Church putting on its show even after the legislature finally gave in to the poll numbers? "It's a PR campaign," explains Frances Kissling, the spokesperson for the D.C.-based group Catholics for Contraception. "They're thinking about the next battle."

So it seems. "Be assured that this attack is not limited to contraception," Cardinal Egan wrote of the bill in his letter. The Church is also bracing itself for a fight over insurance coverage of fertility treatments (some of which it opposes on moral grounds), arguing that such a law would infringe on its religious freedom. Egan's greatest fear: reimbursement for the ultimate sin. "Undoubtedly, mandates in favor of direct abortion will follow shortly."

At the rate the Women's Health and Wellness Act is moving, the Cardinal has little to worry about. Nobody is willing to guarantee that the Assembly and Senate will work out their differences by the end of the legislative session in June. Meanwhile, for as long as these two important health measures are caught in this tangle of politics, women will continue to lose out on preventive care and shoulder the financial cost of birth control.

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