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Covering Birth Control

Why one woman sued.


Erickson, who grew up in Lafayette, Ind., moved to Seattle in 1999. She has worked for Bartell for 18 months and was recently promoted to pharmacy manager. She says she loves her job and considers Bartell -- which operates a chain of 45 drugstores in Washington -- a progressive workplace. But she hates telling customers that their health plans don't cover the contraceptives they need. Even more, she hates watching them turn away angrily.

"One woman recently said to me, 'I have to make rent this month, I have five kids to feed, I can't afford to pay for birth control pills,' " Erickson says. "I want to say to her, 'Don't leave without these!' I feel so bad."

But Erickson's efforts aren't simply aimed at helping others. The fact that her own company's insurance plan doesn't cover contraceptives forces Erickson -- who says she's not ready to have children -- to pay $360 a year out-of-pocket for birth control pills.

While she can afford this expense, she thinks it's unfair that she has to. And there were times in the past when she couldn't. Like many women, she turned to Planned Parenthood, where she was a regular client and a strong supporter. So when representatives from the local chapter said they would help her file a complaint against Bartell with the Equal Employment Opportunity Commission last December, she didn't hesitate.

The resulting lawsuit has made waves for its landmark legal strategy. It charges that a company whose insurance plan covers most prescription drugs but excludes contraceptives violates federal discrimination laws because only women use prescription contraceptives.

Family planning advocates argue that excluding birth control from prescription coverage is not only discriminatory, it's also economically short-sighted. Contraception is far cheaper than the cost of either a pregnancy or an abortion. In 1996, the Health Insurance Association of America estimated it would cost about $16 per person to provide birth control coverage for members of group plans. Compare that to the average cost of an abortion: $316.

"Services for men get covered much quicker than services for women," says Judith DeSarno, president and CEO of the National Family Planning and Reproductive Health Association. It was only 25 years ago that insurance companies agreed to cover the cost of prenatal care. "There's a very clear pattern here," she says. "It's the nickel-and-diming of women's health."

A recent nationwide survey found that two-thirds of Americans want insurers to cover contraception. Currently 13 states have passed laws requiring health plans to pay for contraceptives if they cover prescription drugs to include contraceptives, and 21 states are considering such legislation. Federal legislation has been stalled in Congress since 1997.

The big problem with the state laws, says Roberta Riley, the Planned Parenthood attorney who filed the lawsuit, is that they generally don't apply to self-insured companies like Bartell, which put together their own medical coverage for their workers. Because self-insured companies account for half of all employer-sponsored health insurance, that leaves a large gap. And that, Riley says, was one reason Planned Parenthood decided it was time to go to court.

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