In many states these days, especially in the south, organizations like Planned Parenthood fight to maintain women’s access to contraceptives. But here in Hawaii, their biggest political battles are a bit easier–rather than engage in desperate trench warfare to keep government from making it harder for women to get birth control, they advocate for bills that would actually make access to contraceptives easier.
Like House Bill 1895, which was introduced by a dozen or so House members including Lynn DeCoite, D–East Maui, Molokai and Lanai. The bill expands “access to prescription contraceptives by requiring insurers to cover contraceptive supplies intended to last up to a twelve-month period.” (Its companion bill in the Senate–SB 2319–was introduced by nine senators, including Roz Baker, D–South Maui.)
In testimony on Feb. 5 before the House Committee on Health, Laurie Field, Planned Parenthood’s Hawaii Legislative Director and Public Affairs Manager, expressed complete support for the bill.
“Birth control is highly effective so long as it is used consistently, so a steady and reliable supply is key to reducing unplanned pregnancy,” said Field in her testimony. “Dispensing a one-year supply of birth control is associated with a 30 percent reduction in the odds of experiencing an unplanned pregnancy compared with dispensing for 30 or 90 days. This means that making contraception more accessible also saves money. By preventing just one unintended pregnancy, an insurer will save the cost of a delivery–a minimum of $17,400. That is enough savings to pay for 29 additional years of contraception.”
But other organizations–health insurance firms, pharmacies and even the Hawaii Chamber of Commerce–weren’t so effusive. Though they did phrase their concerns very carefully, typically pointing out that they “support the intent” of the bill before criticizing it.
“With an overabundant supply of prescribed contraceptives, Kaiser Permanente Hawaii is concerned with potential waste if the woman decides to stop using them or decides to switch contraceptives during the course of the year,” John M. Kirimitsu, Kaiser’s Legal and Government Relations Consultant, testified on Feb. 5. Eric P. Douglas, the Government Affairs Senior Director for the pharmacy chain CVS, even wondered why the bill was needed, since the Affordable Care Act made contraceptives free to those with health insurance.
“Perhaps most concerning is that since 2010’s passage of the Affordable Care Act (‘ACA’), contraceptives are required to be covered at a $0 copay/coinsurance benefit to members,” Douglas testified on Feb. 5. “Therefore, no matter how large the days of supply, it doesn’t cost the member any additional dollars to pick up, whether monthly or otherwise. This 12-month provision certainly provides an opportunity for a member to stock up on a year’s supply before quitting their job or dropping their insurance.
Kaiser’s Kirimitsu also speculated that allowing 12-month prescriptions could lead to health risks for women.
“Also, most important is that a woman’s health may be compromised if she is prescribed an overabundance of such contraceptives because there will be no physician monitoring of the drug’s risks and side effects. Through routine monitoring, a physician can discuss suitable alternatives in order to ensure a woman finds the contraceptive method that best suits her and her health best. Arguably, giving a year’s supply of contraceptives may enhance the expectation that the method is acceptable and safe, while a less prescribed supply may encourage the woman to reconsider use of the method at each resupply visit.”
But other medical professionals weren’t having any of that.
“Providing a greater number of birth control pill packs at once is associated with higher continuation rates,” stated the Hawaii Medical Association’s Feb. 5 testimony (the association strongly supports the bill). “Dispensing a greater number of birth control pill packs at once is associated with fewer pregnancy tests, fewer unplanned pregnancies, and decreased health care costs per woman.”
Susan J. Wurtzburg, Ph.D., the Policy Chair for the American Association of University Women, also directly attacked the “increased costs” argument.
“An examination of the 2010 unintended pregnancy rates by states demonstrates that Hawaii scores as one of the most highly ranked states (www.guttmacher.org), ultimately costing individuals and taxpayers vast amounts of dollars, which could be spent in more productive ways, if contraceptive prescriptions were dispensed in a manner suiting women,” Wurtzburg said in her testimony, which was also in support of the bill. “Barriers to taking contraceptive pills consistently include women’s lack of access to transportation, forgetting, pharmacy not filling orders in a timely manner, pharmacists not stocking sufficient amounts of pills, etc.”
The House Committee on Commerce and Consumer Protection will hold a hearing on HB 1895 next, on Wednesday, Feb. 17.