Massachusetts health insurers and reproductive rights advocates have negotiated a compromise bill that would protect free birth control coverage even if the Trump administration strikes that requirement from federal law, as expected.
The Massachusetts Association of Health Plans, a coalition of 17 insurance providers, previously opposed the measure, saying it was broader — and more expensive — than necessary to ensure contraceptive access. But the organization has now signed on to compromise language, and officials intend to testify in favor of the bill at a legislative hearing Tuesday.
“We all had a mutual desire to ensure that women in Massachusetts are protected relative to contraceptive coverage regardless of what happens at the federal level,” said Lora Pellegrini, the association’s president. “We were able to reach agreement on what we think is a sensible bill.”
The bill would go further than the federal requirement, contained in the Affordable Care Act, by mandating coverage of emergency contraception at pharmacies without a copayment or a new prescription. It would also let women with established prescriptions pick up a year’s worth of birth control pills at one time, rather than having the packs meted out monthly or quarterly.
Reproductive rights advocates who pushed the bill had hoped to expand coverage much more broadly than currently required under federal law, mandating free coverage of every type of FDA-approved contraceptive. The compromise dials that back, allowing insurers to control costs by requiring copayments for brand-name drugs if a generic is available for free, unless the patient’s doctor demands it. Insurers would not need to cover oral contraceptives that have no generic equivalent or condoms.
Massachusetts law has long required insurers to provide birth control coverage — but not without copayments. The federal Affordable Care Act five years ago recast contraception as preventative care and required that all private insurers provide it, free of charge.
But religious organizations and employers who disapprove of birth control have challenged that requirement in court, arguing that providing birth control to others violates their own beliefs.
The Trump administration has tried to answer those concerns by rewriting the birth control regulation in an effort that has run parallel to its attempted repeal of the Affordable Care Act. A draft regulation, not yet finalized, would essentially eliminate the mandate by allowing any company to opt out of covering birth control. Unlike the repeal, the change in regulation does not require congressional approval.
In Massachusetts, some Catholic organizations intend to oppose the latest bill, saying it would compel them to provide birth control and emergency contraception, which they believe can cause abortions.
“They call it an ‘access’ bill, but, in fact, it’s about expanding a mandatory subsidy which coerces the consciences of Catholics and others who are opposed to contraceptives and sterilizations and abortifacients,” said C. J. Doyle, executive director of the Catholic Action League of Massachusetts.
The bill offers religious exemptions consistent with current state law, but Doyle said he believes it could require Catholic hospitals, colleges, and charities to fund employee birth control benefits.
“The religious exemption is just tokenism,” he said. “It would seem that it would really only apply to church entities themselves.”
The bill being considered Tuesday would continue the mandate for Massachusetts companies and insurers, with one big caveat: It covers only traditional health plans offered by employers who pay a premium to an insurance carrier. Sixty percent of the state’s market is self-insured, said Pellegrini, meaning that the companies structure their own coverage and could still opt out of copay-free birth control, if the Trump administration rule is finalized.
MassHealth, the state’s version of Medicaid, would be required to comply.
Blue Cross Blue Shield, which is not part of the association, backed the legislation from the start.
“We support this legislation because it’s the right thing to do,” said Elana Margolis, senior director of state government and regulatory affairs for the insurer. “Access to preventative care, to birth control, keeps people healthy and it saves money.”
Seven other states and the District of Columbia have already established laws requiring no-copay coverage of contraception, in an effort to gird against the changes forecast by the Trump administration. Several other states are considering similar plans, according to Planned Parenthood.
The bill also aims to fix aspects of the birth control coverage guaranteed by the Affordable Care Act that women have found problematic, such as the morning-after pill, participants said.
Emergency contraception, now offered over the counter at a cost of about $50, can be acquired for free under the Affordable Care Act, but only with a doctor’s prescription. Massachusetts advocates pointed out the irony of that: Emergency contraception must be used within a few days of unprotected sex to be effective. Scheduling a doctor’s visit to get a prescription can be prohibitively time-consuming.
But insurers were troubled by the request that the morning-after pill could be dispensed and covered by insurance without a prescription. “We were concerned that women could buy it for other women. People could have used it as a substitute for birth control,” Pellegrini said.
Then they considered another public health model: the flu shot.
Pharmacies now have standing orders for flu shots that patients can request to be applied to their insurance coverage. The bill seeks a similar process for emergency contraception, making the prescription automatically available to women if they need it.
The measure also would allow women to pick up more packets of birth control pills at one time than insurers have traditionally allowed. Contraceptive advocates say that limiting the supply increases the chance of inconsistent use by women who may miss a dose or skip a month. That, in turn, increases the risk of unintended pregnancy.
Insurance providers concerned about fraud, waste, and abuse negotiated a compromise: a prescription will be limited to three months when it’s new. If the patient is satisfied, she can get a 12-month supply.
Johanna Kaiser, media relations manager for the Planned Parenthood Advocacy Fund of Massachusetts, said that’s important for women who travel or who live in rural areas and who can have difficulty picking up their pills exactly when the prescription is available for renewal.
One method of birth control that still wouldn’t be covered under the bill is male sterilization. Activists had aimed to extend birth control coverage to vasectomies sought by men, but the Massachusetts Association of Health Plans balked at that feature, concerned, on principle, about the imposition of another mandate, Pellegrini said.
Many plans already cover vasectomies as an option for men to prevent future pregnancies, Pellegrini noted.