Health Insurers Pressure Senate to Curtail Increased Birth Control Access

The health insurance industry lobbied aggressively Monday to convince Sen. Laurie Monnes Anderson, D-Gresham, and the Senate Health Committee to dramatically pare back a House bill that increased the supply of birth control a woman could get from a single prescription to 12 months.

Meanwhile, the House Rules Committee is expected to approve later today a revived effort from Rep. Knute Buehler, R-Bend, to allow women to get oral contraceptives or a hormone patch directly from the pharmacist without visiting a doctor or nurse practitioner.

Women’s health advocates thought they had a winner when the House passed House Bill 3343 by a 55-2 margin, with Republican representatives lining up to speak in support the bill, including Rep. Cedric Hayden of Cottage Grove, Rep. Jim Weidner of McMinnville and Rep. Jodi Hack of Salem.

But the health insurance industry seemed to have the upperhand at Monday’s meeting, as no House Democrats showed up to support HB 3343, leaving women’s health advocates to fight for the bill alone, while conservative business groups and Rep. Julie Parrish, R-West Linn, one of just two House opponents, testified against a 12-month supply with the health insurers.

And in the weird political dynamics of the Oregon Capitol, Senate Democrats, even with their expanded majority, cannot be assumed to be as progressive as the House Republicans.

The amendment from the health insurance industry would allow for a maximum of six months instead of a year for contraceptives, while also allowing insurers to require women to make monthly trips to the pharmacy for each new prescription during the first six months, effectively requiring seven trips instead of the two outlined in House Bill 3343.

Monnes Anderson told The Lund Report after the meeting that a closed-door caucus meeting of Senate Democrats on Tuesday would likely decide the fate of yet another progressive bill.

Perhaps afraid the Senate Democrats might get cold feet, Rep. Jennifer Williamson, D-Portland, stepped up the pressure on them Tuesday by circulating a petition asking for grassroots support for the 12-month policy.

Despite the tense Senate Health hearing, Sen. Alan Bates of Medford, said Wednesday he walked away from the meeting with his fellow Senate Democrats confident that the health insurers would not get their amendment. “I think the 12-month thing is going to go,” he said.

The Oregon Health Plan and the state Contraceptive Care Program already offer 12-month disbursements of the pill, since scientific studies have shown that the risk of pregnancy is reduced by 30 percent when women are given such easy access to birth control. Data from that program showed only about 1.2  percent of women needed more than the standard amount of contraceptives, according to Planned Parenthood Advocates of Oregon.

The policy has existed for years at the state level, since birth control, which costs $200 to $700 a year is much cheaper than a $20,000 unplanned pregnancy. Preventing unplanned pregnancies also saves money for the Department of Human Services, which helps women and families financially support children.

But in a display of the pennywise and pound-foolish nature of the American healthcare system, health insurers, which have a steep incentive to maximize short-term profits while having less concern for the overall long-term cost to the system, are fighting the mandate.

Health insurers and their allies argue some women might waste birth control or switch insurers after one company pays for the prescription. But they also used the slippery-slope argument that giving women better access to birth control might open the door for the Legislature to require 12-month disbursements for other chronic medications.

Buehler, a physician-legislator who advocates for pharmacists to prescribe birth control in House Bill 2879, said he was surprised at the insurance industry’s opposition to 12-month disbursements, noting a 25 percent decrease in unintended pregnancies if a woman has unfettered access to contraceptives. “It’s really a cost benefit,” he said.

But he added that the pharmacist prescription bill would take away a lot of the need for 12-month disbursements. “If you can go into Walgreens to pick up your pills any time you like, why would you want a year’s supply?”

HB 2879 as amended would allow adult women to get birth control medication from a pharmacist without a doctor’s prescription for up to three years. The medicine would be stored behind the counter, similar to Sudafed and a pharmacist would be trained to screen patients for birth control. Teenage girls would also be able to get a prescription from the pharmacist, but only if a doctor or nurse practitioner had already started them on hormonal contraceptives.

Buehler discussed the matter with Tom Holt of Regence BlueCross BlueShield, who did not express strong opposition to increasing birth control access in their private conversations.

Mary Nolan, interim executive director of Planned Parenthood Advocates of Oregon, pointed out that the insurers’ slippery-slope argument is a logical fallacy. There are a number of instances where the Legislature has extended very limited prescribing powers to nurses and psychologists, she said.

“The research shows significant benefits to those who receive 12-month supplies,” said Nolan, a former representative and Oregon House Majority Leader. “We’re not aware of any medical research that suggests a different time.”

Mandate Saves Money

Perhaps the most obvious hole undermining the insurance industry’s position is the fact that the Affordable Care Act requires states to bear the cost of any new mandates if they increase costs to insurers. But the legislative fiscal office found no cost to the state, the Oregon Educators Benefit Board, or the Public Employees Benefit Board, likely because the mandate in HB 3343 is expected to save money.

That Affordable Care Act provision would likely prevent Oregon from passing laws to require 12-month supplies of drugs if the policy imposed a net cost to insurers since the state would need to use general fund money to compensate insurers.

The insurers were aided in testimony by conservative business groups, including Associated Oregon Industries and the National Federation of Independent Businesses. The latter infamously took at least $850,000 from the health insurance industry before serving as the chief plaintiff in the 2012 Supreme Court case that sought unsuccessfully to derail the Affordable Care Act.

The National Federation of Independent Business lobbyist, Janet Meekcoms, opposed the bill, but supported the amendment, and dismissed concerns that the access restrictions in the amendment would result in an increase in unplanned pregnancies.

Her testimony directly contradicted both the Republican Buehler and the recommendations of the Centers of Disease Control and Prevention:

“The more pill packs given up to 13 cycles, the higher the continuation rates. Restricting the number of pill packs distributed or prescribed can result in unwanted discontinuation of the method and increased risk for pregnancy.”

Monnes Anderson raised concerns about the ability of women to safely keep the medication, but Buehler told The Lund Report that the handling instructions for oral contraceptives are not that different from other medications, such as keeping them at a temperature below 40 degrees Celsius -- 105 degrees Fahrenheit.

“I think we should go where the science takes us,” said Sen. Chip Shields, D-Portland. “Twelve months provides us the most bang for the buck.”