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.
"It's inappropriate to take cost-effectiveness figures and propagate them to a higher-income, employed population," said Tom Wildsmith, policy research actuary for the Health Insurance Industry of America, a trade association.
Forcing employers and insurers to cover birth control will only exacerbate high health insurance costs, Wildsmith said.
"It's understandable why if you think something is important you would want someone to pay for it for you. But you can add on nice things to the point where insurance is less affordable than it is now," he said.
An estimated half of traditional indemnity plans and preferred provider organizations, 20 percent of point-of-service networks, and 7 percent of health maintenance organizations cover no contraceptive methods other than sterilization.
Although women's activists say the best "prescription equity" laws cover the full range of contraceptive needs with no loopholes, 11 states allow an exemption on religious grounds. That's OK, some women's advocates say, as long as the employer or insurer is not just tangentially connected to a religious institution, such as a religiously affiliated hospital.
Women's groups say they're facing less opposition now than when they started pressing the issue years ago. Some companies are even starting to offer contraception coverage on their own, such as the Chrysler Group, the American subsidiary of German automaker DaimlerChrysler AG, which this month expanded its employee benefits package to include coverage for prescription contraceptives.
While some anti-abortion activists may have reservations about the government requiring coverage for contraception and reproductive services, they have not lined up in overwhelming numbers on the contraceptive coverage issue.
However, in some parts of the country, anti-abortion activists are fighting public funding for birth control. In Kentucky, hard-line abortion foes are lobbying a public health board to turn down federal family planning money used to dispense birth control pills to women, saying the contraceptives are the equivalent of an abortion.
Both sides of the abortion debate will be watching that vote when it takes place tonight.
Overall, though, Janet Krepps, staff attorney for the New York-based Center for Reproductive Law and Policy, says attitudes about insurance coverage for birth control are changing.
"As people have become more educated about the issue they've realized that this is basic fairness and health care," she said. Also, predictions about the economic effects of contraceptive coverage just did not bear out, she said.
"There was all of this doom and gloom that [birth control coverage] would cause increases in premiums and costs, but that hasn't been realized," Krepps said.