By Pamela Wood
Advocates say a new Maryland law will place the state at the forefront of efforts to require insurance plans to offer birth control at no out-of-pocket cost, expanding access to women and men who want to prevent unwanted pregnancies.
The law goes further than President Barack Obama's Affordable Care Act, which already reduced costs for women seeking birth control in many cases.
Under the Contraceptive Equity Act, Maryland will be the first state to require insurance companies to cover over-the-counter emergency contraceptives, such so called morning-after pills, at no cost. Maryland also will be the first state prohibiting out-of-pocket costs for men who have vasectomies.
Advocates who pushed the bill through the General Assembly say Maryland is the first state to pass such a comprehensive approach.
"Maryland is on the forefront across the board with this act," said Karen Nelson, president and CEO of Planned Parenthood of Maryland.
Other provisions prohibit co-payments for any type of contraceptive and also ban preauthorization requirements for long-acting contraceptives such as IUDs. The law allows women to receive six months' worth of birth control pills at one time.
Del. Ariana B. Kelly, a Montgomery County Democrat who shepherded the bill through the legislature, said the act will make a "huge difference in people's lives."
Republican Gov. Larry Hogan is expected to sign the bill into law Tuesday, along with nearly 200 other bills that lawmakers passed this year.
The law won't go into effect until Jan. 1, 2018 -- timing that will allow insurers to prepare for the 2017 open-enrollment season -- and will apply only to insurance companies regulated by the state of Maryland. Some insurance plans that Marylanders have will not be covered, such as those that are issued from other states.
The bill was opposed by some Republicans in the General Assembly, though party leaders in both the House of Delegates and the state Senate voted for it. Matthew A. Clark, a Hogan spokesman, noted federal law already requires at least one type of all forms of contraceptives to be covered with no co-payment.
The act was designated as one of the top-priority bills by the Democratic leaders, House Speaker Michael E. Busch and Senate President Thomas V. Mike Miller Jr. Half of the state's lawmakers co-sponsored the bill.
Kelly called the bill the most important piece of birth control legislation since 1998, when Maryland first required insurance companies to cover birth control. She said it closes "gaps" left by the Affordable Care Act, which is often called by its nickname, Obamacare.
For example, the Affordable Care Act requires that for each of 18 categories of contraceptive, only one type must be offered to patients with no co-payment. That means a woman taking birth control pills might have to choose between the formulation that works best for her and a formulation that's covered without a co-payment, Kelly said.
Kelly said the bill met some resistance from insurance companies, but she talked with them through the legislative process. She believes the final version is one that insurance companies can live with.
"It was a very difficult bill to get through because it costs insurance companies money," Kelly said.
Officials with CareFirst BlueCross BlueShield, Maryland's largest insurer with 2.1 million customers, declined to comment.
The requirements are likely to cost more money in the short term. State analysts estimate that Medicaid, for example, will spend about $1 million more per year for women who receive six months' worth of birth control pills at a time. Companies could pass along the increased costs to consumers in the form of higher premiums.
Proponents hope the long-term savings of preventing unwanted pregnancies will more than offset the short-term expenses.
Dr. Peter L. Beilenson, president and CEO of insurer Evergreen Health and a supporter of the bill, said his organization's plans already cover most of the requirements in the new law at minimal expense.
"It's preventive care. It's frankly not expensive at all," said Beilenson, who previously served as the top health official for Baltimore City and Howard County. Evergreen Health has about 40,000 members in Maryland.
Beilenson said that requiring insurers to provide long-acting reversible contraceptives -- such as Norplant and the Depo-Provera shot -- as well as intrauterine devices without doing a preauthorization first could actually save money for health insurance companies. Insurance companies almost never deny them, so preauthorization is only an exercise in paperwork, he said.
Nelson, of Planned Parenthood, said Maryland is breaking new ground in allowing men to get vasectomies without paying out of pocket. Women's sterilization already was covered at no cost to the patient.
Maryland also will be the first to require insurers to cover emergency contraceptives at the point of purchase. Currently, if a woman's insurance covers emergency contraception, she often must pay for it up front -- at a cost of about $50 -- and then seek reimbursement.
She said Maryland is taking a bold step by making it easier and cheaper for people to get birth control.
"When so many states and so many pockets of the country are trying to take away reproductive health care and take away rights of women, Maryland is saying, 'We are going to provide more health care coverage and more access to birth control.'"
Some parts of Maryland's bill mimic laws already on the books in other states. Oregon and Washington, D.C., for example, require insurance companies to allow women to obtain 12 months' worth of birth control pills at a time.
"Many other states are implementing piecemeal provisions, but there's nothing as comprehensive as this act," Nelson said.
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