"I couldn't afford $40 a month (for pills) and I certainly couldn't afford to have another baby for a long time," says Edith, who requested that her last name not be used. She eventually switched to a less expensive pill, and then went off it altogether, opting to use a cheaper but less effective method of contraception.
As Edith sees it, contraception is part of her basic health care, and should be covered by her insurance. But according to Gil Dupré, people like Edith and her husband are to blame for the high cost of health insurance.
Not every insured person is entitled to every health benefit out there, says Dupré, chief executive officer of the Louisiana Managed Healthcare Association. "Health coverage does not mean coverage of every single dollar spent on health care for the consumer," he says.
"[Birth control pills] are only $30 a month," Dupré continues. "Well, $30 a month is affordable for most people, and people who want to protect themselves against pregnancy -- that's what they are going to do. They are going to spend $30 a month."
On June 12, the Louisiana Legislature struck down a bill that would require most insurers to cover prescription contraceptives in comprehensive health plans. That very same day, in Seattle, U.S. District Judge Robert S. Lasnik ruled that prescription contraception was "a fundamental and immediate health care need" for women, and that an employee insurance plan failing to cover contraception violated federal sex discrimination law.
Reproductive-rights advocates hailed Lasnik's ruling and used it as a launchpad for a campaign urging employers to add contraceptives to their health care plans. The implication: Do it, or you might get sued.
Planned Parenthood offices nationwide distributed informational brochures aimed at workers and employers. "The failure to cover contraception is sex discrimination, plain and simple," reads one brochure, "and the court clearly agrees." It goes on to quote Lasnik's ruling.
"We're trying to educate employers," says Julie Redman, chief executive officer for Planned Parenthood of Louisiana and the Mississippi Delta. "They need to do the research in order to protect themselves from liability and provide an important health benefit."
Two weeks ago, Texas became the 16th state in the country to mandate that comprehensive health plans must include contraceptive coverage. In Louisiana, leaders on both sides of the debate say they're readying for the proposed law to resurface during the 2003 legislative session.
"It's an important issue in terms of fairness," Redman says. "It has to do with equal treatment for women because contraception is very basic health care for women. It's not a luxury."
Representatives of Louisiana's insurance industry say they are nonplussed by Lasnik's ruling, because many health plans already cover prescription contraceptives. What they're worried about is the state ordering coverage of specific health costs.
"It's not that the health industry objects to providing coverage for contraceptive drugs," Dupré says. "We have a position on mandated benefits. Generally, they are costly. They force some people out of the health industry market in Louisiana. About 11 percent of the premiums that people in Louisiana pay is to pay for mandated benefits. These people did not choose to buy [them], but they are not given the opportunity to buy without them."
Advocates of contraceptive coverage argue such costs are low, citing a 1998 study by the nonprofit Alan Guttmacher Institute, a reproductive research organization. The report showed the average cost of adding contraceptives to a health plan equaled less than $2 per month per employee. Such expenses, contraception advocates argue, are miniscule compared to the costs of an unintended pregnancy.
"You'd think it would be less expensive for them to just cover birth control pills than to pay for the birth of a baby and all the expenses that are incurred," says Edith, whose health plan stopped paying for contraceptives while she was pregnant with her first child.
"I had complications during pregnancy and then my daughter needed surgery and generated a ton of expenses. I thought [the insurance company] would be psyched to get me back on the pill."
Planned Parenthood's New Orleans spokeswoman, Christina Kucera, says that organization is trying to convince employers that covering contraceptives is a good business decision. "Insurance plans cover healthy pregnancies, 80 percent of them cover abortions, 60 percent cover sterilization," Kucera says. "For some reason they choose not to cover contraception. From a fiscal standpoint, it doesn't make sense for an employer not to do this."
That includes small business owners, says Mimi Bowen, a Planned Parenthood board member and owner of the Uptown fashion boutique Mimi. Bowen, who employs six full-time and part-time workers -- all women -- believes it's "stupid" not to cover contraceptives in an employee health plan. "It's cheap in the short run ... it's nothing compared to what it costs to have a baby, or worse, an abortion," Bowen says.
"It's certainly not that expensive when you think about what happens when an employee gets pregnant and you've spent years training them, and she goes off and has a baby and you have to pay for all that. Not to mention the lack of the employee that you've been training."
Dupré, of the Louisiana Managed Healthcare Association, says he's not arguing with specific points made by contraception advocates. "The argument is somewhat moot," he says, emphasizing that the industry opposes any mandated benefit. "It's still important for employers and health plans to be able to maintain the right to design coverage."
Mandated benefits, Dupré says, drive up the cost of health insurance for everyone. "Another example of a mandated benefit -- one a lot more expensive than contraceptive drugs -- is in vitro fertilization. There's a lot of sympathy for people in the predicament of not being able to bear children in the natural way, but that applies to a very small percentage [of people]. The argument is, should everybody else pay for that benefit?"
Louisiana legislators this year rejected various forms of a bill sponsored by Sen. Paulette Irons, D-New Orleans, that would mandate contraceptive coverage. Irons' bill originally said all employers must include contraceptive coverage in their employee health plans. It was then amended to include a "conscience clause" excluding religion-based employers whose beliefs prohibit providing contraception.
The legislation was further restricted to provide coverage only to women who need birth control pills for non-contraceptive reasons, such as treating gynecological conditions such as endometriosis or fibroid cysts and tumors. The legislation still failed.
"We got to the point of asking whether [pills] could be covered if they were medically necessary," Irons says. "They did not want to even talk about it, and to me it's at a point where you can't even reason with them. There were myths that were created by the other component. People testifying that birth control pills are an abortive agent, that birth control pills cause cancer, that the women of Louisiana are all going to become promiscuous if this happens."
Opponents of mandatory contraceptive coverage include not only the insurance industry but the Roman Catholic Church, whose teachings prohibit the use of birth control. The church equates such a law with forcing Catholics "to pay for something we don't believe in," says David Hamilton, a Baton Rouge attorney and lobbyist for the Louisiana Catholic Conference.
The argument for non-contraceptive use of the pills doesn't placate the Catholic Church, says Hamilton. Nor would a "conscience clause." Hamilton says the issue involves individual Catholics, both business owners and employees, who would be forced to contribute to an insurance pool that helps pay for contraceptive use by other people.
"The conscience clause dealt with religiously affiliated employers such as a church or school, and not with the whole issue of Catholic employers," Hamilton says. "I'm a Catholic employer and I'm not religiously affiliated, so there's a problem."
Hamilton says it would violate his religious beliefs to contribute to an insurance plan that pays for contraceptives. He says he gets irritated with opponents' claims that the church's opposition to such a law demonstrates a lack of concern for women's health. "We, the Catholic Church, will put our record of taking care of unwed mothers and children up against anybody, including the government of the United States of America," he says. "We educate, we counsel, we provide adoption services, we provide resettlement services. Our social programs have always been in the forefront."
Yet people like Trudy Giannobile, who lives in the Baton Rouge suburb of French Settlement, support a law like Irons' proposed legislation because they believe it would make a big difference in their everyday lives.
Giannobile, 32, became pregnant with her second child nine months after she gave birth to her first. The second pregnancy was unplanned, the result of an inability to afford prescription contraceptives on a budget that had been recently whittled down to one income. After the birth of her second child, Giannobile's doctor advised her against getting pregnant anytime soon. "She told me it was unhealthy for me to have them so close together, and I needed to space them out a little bit more if I had any more."
"My thoughts were, 'If we're paying health insurance, why won't they pay for birth control?' We couldn't afford it, and I had to get off birth control pills and use other means. It was just too expensive."
- Julie Redman