Much ado about a mandate

by Bill Hammond |  | NY Torch

In addition to being one of the wedge issues that paralyzed the state Senate this week, the Comprehensive Contraceptive Coverage Act is also an insurance mandate. And like the dozens of other mandates pending in Albany, it’s being debated without a clear analysis of costs and benefits.

Contrary to what its name suggests, the bill is not about ensuring coverage of birth control pills, IUDs and other contraceptive drugs and devices. That coverage is already mandated, without cost-sharing, by existing laws and regulations at both the federal and state level.

The bill’s practical effects would be incremental, including eliminating cost-sharing for sterilization procedures such as vasectomy and tubal ligation, and allowing patients to receive 12 months’ worth of contraceptives with an initial prescription.

The legislation was originally proposed in January 2017 by then-Attorney General Eric Schneiderman, who resigned last month after several women accused him of assaulting them.

Back then, President Trump was about to take office and congressional Republicans were vowing to repeal the Affordable Care Act (ACA), which included birth control as one of the preventive services that all health plans must cover without cost-sharing (meaning copayments, coinsurance and deductibles). New York law also requires coverage for birth control, but did not prohibit cost-sharing.

Since then, however, the GOP’s attempts to repeal and replace the ACA have repeatedly failed—and its provisions relating to birth control remain in largely in force. The Trump administration broadened exemptions for certain employers with religious or moral objections to contraception, but those are overridden in New York by state law.

Last year, the Cuomo administration issued regulations barring cost-sharing for contraceptives and requiring plans to provide at least a three-month supply on the initial prescription, and a 12-month supply on subsequent refills.

With the original legislation rendered largely redundant, its main function now is as a political symbol—with supporters portraying it as a boost for reproductive rights and women’s rights generally.

This week, Democrats tried to attach the Comprehensive Contraceptive Coverage Act as a hostile amendment to unrelated legislation in the state Senate, as a way of forcing Republicans to cast politically awkward votes. Democrats did the same with the Reproductive Health Act, which would restate and broaden the legalization of abortion in state law.

Lacking votes to block the maneuver, Senate Republicans responded by abruptly adjourning—and the house was unable to pass any bills for the rest of the week.

With respect to the Comprehensive Contraception Coverage Act, the political squabbling has overshadowed substantive flaws—which should concern even those who wholeheartedly support birth control.

Take, for instance, the focus on eliminating cost-sharing. The issue is largely moot for now, since that policy is already established by federal law and state regulation. But even if those laws and regulations went away, it’s not clear that the state should be wiping out cost-sharing for all contraception users at all income levels, including wealthy people who could easily afford a copayment of $30 or $50 a month. One side effect of that unnecessary benefit is marginally higher premiums for everyone, including lower-income insurance customers who don’t need or use contraceptives at all.

Nor is there an obvious reason why contraceptives should be provided a year’s worth at a time, when life-saving medications such as insulin are not. Twelve-month prescriptions would be wasteful if, for example, a patient decides to go off birth control or change contraceptive methods a few weeks later after filling one.

The bill also sets the precedent of prohibiting cost-sharing for sterilization, which is an elective surgical procedure as opposed to a drug or device. Why shouldn’t it get the same treatment as removal of a cancerous tumor or repair of a cleft palate?

How much higher this particular bill would push premiums is unknown. The Legislature never formally analyzes the cost impact of insurance mandates, despite voting 11 years ago to do just that.

But if these provisions become law, other patient and provider groups would undoubtedly seek similar enhanced coverage for drugs, devices and procedures important to them. And New York’s health insurance premiums, already among the highest in the country, would grow costlier still.