Within weeks of hitting the U.S. market in 1998, more than half of Viagra prescriptions received health insurance coverage. If many women weren't already outraged that they had to pay for birth control out of pocket, they were infuriated at the preference given to the anti-impotence pills.
But the fury over Viagra may have given the fight for contraception covered under insurance plans just the momentum it needed. Women's groups say they're making significant progress in their battle to get reimbursed for birth control, even though insurers still argue that covering contraception will boost already skyrocketing health-care premiums.
This week, New York became the 20th state to require that insurers and employers provide contraceptive coverage. That means that half of U.S. women now live in states requiring at least some birth control coverage, according to Planned Parenthood. Massachusetts and Arizona passed similar bills earlier this year that will go into effect in 2003.
So far, women's groups have fought the battle piecemeal: state by state and insurer by insurer. But today, a congressional subcommittee is taking up a bill that would fill what women's groups say is a gaping hole in birth control coverage by requiring plans that fall under federal law to reimburse for contraception.
Although the bill has been introduced for several years in a row without being passed, women's rights activists are more optimistic this time around.
"I think there's a big groundswell right now," said Gloria Feldt, executive director of Planned Parenthood, which also filed a discrimination complaint against the Dow Jones Co. for not covering birth control. "I would say it's an idea whose time has come — it's past time. When it comes to health insurance, men have been getting a better deal."
Studies have shown that women of reproductive age spend about two-thirds more than men on out-of-pocket health-care costs. Birth control and reproductive health-care services are believed to account for much of the difference.
Since the most effective forms of birth control, such as the pill, are only available by prescription and can be relatively expensive for some, a lack of insurance coverage can put contraception out of reach for some, women's groups say. Birth control pills cost an estimated $30 a month plus doctor's fees.
Women's activists say they cannot understand why, given what they see as the "cost-effectiveness" of birth control, employers and insurers wouldn't jump to cover it. They point to studies that found for every $1 of public funds invested in family planning, $4 to $14 of public funds is saved in pregnancy and health care-related costs.
"Insurance companies have got to realize there's no financial disincentive," Feldt said. "[Covering contraception] saves so much on the other end. Over the long term, contraception coverage seems to save money."
Insurers, though, say the cost-effectiveness figures cited by women's groups are misleading. While investing public money in family planning for poor women may make good economic sense, women in middle- and upper-income brackets, who are more likely to have health insurance, will not likely risk pregnancy just because their health insurance does not cover birth control.