Womenstake

Emergency Contraception – Some Good News and Some Bad

by Ellen Newcomb, Program Assistant, 
and Jen Swedish, Health Law Fellow, 
National Women’s Law Center 

Last Wednesday, the FDA approved a generic version of the emergency contraception pill, Plan B. For now, this new generic version of emergency contraception (EC) will only be available with a prescription to women ages 17 and under. The generic (thus, less expensive) version may become available over-the-counter to women 18 and over in August, when Duramed Pharmaceuticals will no longer hold marketing exclusivity for nonprescription use of Plan B. (You may recall that a court recently ordered the FDA to make EC available to 17-year-olds without a prescription and to reconsider its decision to impose any age restrictions at all on nonprescription use of EC. The FDA has begun the process to enable 17-year-olds to access EC over-the-counter, but – for now – 17-year-old women still need a prescription, but they will have access to the generic version of EC.)

Currently, over-the-counter Plan B can cost up to $55 for women 18 and older. Private insurance companies may not cover Plan B because drugs sold over-the-counter are often not covered by insurance, and some state Medicaid programs won’t cover it at all. The generic version will lower the cost of EC, making EC more accessible for the women who need it.

But, with the good comes the bad. Arizona and Louisiana are both about to enact laws that will make it more difficult for women to access EC and other vital reproductive health care services.

A harmful refusal bill in Arizona has successfully made its way through the state House and Senate and is waiting for Governor Jan Brewer’s signature. Among other anti-choice provisions, HB 2564 allows any pharmacy, hospital, or health professional, or any employee thereof, who cites a moral or religious objection, to refuse to provide EC. If this bill is enacted, Arizona hospitals could deny EC to sexual assault survivors and pharmacists could refuse to provide EC to women who need it, even though EC is a time-sensitive drug that is most effective in the first 12-24 hours after birth control failure, unprotected sex, or sexual assault. In addition to allowing refusals for EC, the Arizona bill would also allow pharmacists and pharmacies to refuse to fill prescriptions for some of the most widely used forms of birth control. We’re hoping that Governor Brewer recognizes that this bill will harm women’s access to vital health services and that she’ll veto the bill.

Wasting Women's Time with Abortion Restrictions

by Jen Swedish, Health Law Fellow, 
National Women's Law Center

As you are probably aware, this is National Women’s Health Week, and the theme is “It’s Your Time.”  Since Monday, my colleagues have blogged and vlogged about the importance of timing for women in health care – and health insurance coverage, in particular. 

Timing is also crucial for women seeking reproductive health care services.  Twenty-four states currently require women to receive counseling and then wait, usually for 24 hours, before they can receive abortion care.  Proponents of these laws often argue that the counseling and waiting period is essential to ensure that a woman seriously considers the information she has been given before she decides to have an abortion.  Opponents, on the other hand, contend that women are able to make informed decisions about their pregnancies without state-mandated counseling and waiting periods. 

A new report from our friends at the Guttmacher Institute provides fodder for the opponents’ arguments.  Guttmacher found that these laws do not, in fact, cause women to change their minds about having an abortion and, in reality, have very little impact on birth and abortion rates.  A troubling finding of the report indicates that mandatory counseling and waiting period laws may actually postpone the timing of some abortions, increasing the likelihood of more expensive and less safe second-trimester procedures.

As National Women’s Health Week draws to a close, I’d like to emphasize that mandatory counseling and waiting period laws needlessly waste women’s valuable time without benefiting their health. 

New EC in the ER Laws Protect Survivors of Sexual Assault in DC and Utah

by Jen Swedish, Health Law Fellow, 
National Women's Law Center 

As I’ve blogged about before, thus far in the 2009 legislative session, state legislators around the country have introduced a number of bills related to emergency contraception (EC). EC, also known as the “morning after pill,” is a safe and effective way to prevent pregnancy, which is most effective if used within the first 12-24 hours after sex.

Timely access to EC is especially important for survivors of sexual assault, which DC and Utah recently recognized by enacting new EC in the ER laws. These EC in the ER laws require that emergency rooms provide sexual assault survivors with information about and access to EC. With their newly enacted laws, DC and Utah join fourteen other states in recognizing that EC is a critical component of a comprehensive medical response to sexual assault. Kudos to DC and Utah!

Pharmacy Refusals 101: State Legislative Update

by Jen Swedish, Health Law Fellow, 
National Women’s Law Center  

As we’ve mentioned before, the problem of pharmacist refusals just isn’t going away! Around the country, pharmacists refuse to fill valid prescriptions for contraception or sell emergency contraception over-the-counter (EC OTC) based on their personal beliefs. The issue also continues to receive attention from state legislators, as shown in our newly updated Pharmacy Refusals 101 factsheet.

So far in the 2009 legislative session, 12 states are considering 19 proactive bills to prohibit or limit refusals. The majority of these bills would prevent pharmacies or pharmacists from denying access to contraception based on personal beliefs, including 12 bills that would apply to EC OTC. 

Unfortunately, legislators on the other side of the issue are also actively working on this issue. So far, legislators in 11 states have introduced 14 bills that would permit pharmacists to refuse to fill prescriptions based on their personal beliefs without providing any protections for the patient. A few of these refusal bills are moving:

• In mid-March, an omnibus anti-choice bill passed out of Arizona’s House of Representatives and is now awaiting action in the Senate. Among other provisions, this bill would allow pharmacies and pharmacists who cite a moral or religious objection to refuse to provide EC. 
• Just this week, Idaho’s House passed a bill allowing a pharmacist to refuse to provide any drug that violates his or her conscience with no protection for the patient. The bill now goes to the state Senate.
• Last month, a Missouri refusal bill was voted out of committee and is currently awaiting action on the House floor. This bill would allow pharmacies to refuse to dispense “abortifacient[s], including but not limited to the RU 486 drug and emergency contraception” – incorrectly classifying EC, an FDA-approved contraceptive, as an abortion pill despite medical consensus to the contrary.

We’re hoping that none of these refusal bills moves any further through their state’s legislative process, but we’ll keep you posted. For more information on pharmacy refusals in the states, check out the extensive resources on our website.

BUYBCD Update: EC in the States

by Jen Swedish, Health Law Fellow
National Women’s Law Center

Today, organizations across the country are participating in Back Up Your Birth Control Day, a campaign to improve access to and educate the public about emergency contraception (EC). 

In honor of BUYBCD, here’s a “state of the states” update on EC-related bills introduced so far in state legislatures across the country.

First, the good news:

• EC in the ER bills to mandate that emergency rooms provide sexual assault survivors with information about and access to EC have been introduced in 12 states thus far in the 2009 legislative session.  An EC in the ER bill is currently awaiting the governor’s signature in Utah, and the Virginia legislature recently passed a measure allowing sexual assault nurse examiners to provide EC to survivors of sexual assault.

• Expanding access to EC – On Monday, a federal court took significant steps to improve access to EC for those younger than 18.  In the meantime, two states have introduced bills this session to permit pharmacists to dispense EC to women of all ages without a prescription from a doctor.  In addition, legislators in New York have introduced a bill that would make EC available upon request to any student at a public college or university in the state.

• Educating the public about EC – A West Virginia bill would implement a pubic education campaign about EC to counter a lack of awareness among both consumers and pharmacists.

• Pharmacist refusals still prevent women from accessing EC.  Thus far in the 2009 legislative session, twelve states have introduced bills to prohibit or limit refusals based on personal beliefs, including seven states that would also explicitly protect access to non-prescription EC.

No One Likes a Copycat

by Jen Swedish, Health Law Fellow
National Women’s Law Center

As we’ve blogged about before, since the 2007 Supreme Court decision, Gonzales v. Carhart, many state legislatures have tried to copy the federal ban on a medically-approved abortion procedure with no exception to protect a woman’s health. These copycat bans are unnecessary—the federal ban is already in effect in every state, so state bans would not prevent a single abortion. Anti-choice state legislators simply want their own versions of the federal law to penalize doctors more harshly. 

According to our friends at the Guttmacher Institute, copycat bans have been introduced in 7 states thus far in the 2009 state legislative session. A few of these bills are moving:

• In early March, Kansas’s copycat ban passed the House, and it’s now in the Senate.

• Last week, Arizona’s copycat ban, which we’ve mentioned before, passed the House. It now goes to the Senate, where a companion bill is already pending.

One bill has even become law already—Arkansas’s copycat ban moved swiftly through the state legislature and was signed by the governor in February. 

Someone should clue these states in—no one likes a copycat!

Pharmacist Refusals: What Would You Do?

by Jen Swedish, Health Law Fellow
National Women’s Law Center

What would you do if a pharmacist refused to fill your prescription for birth control pills, saying it was against his personal beliefs? What if it wasn’t your prescription being refused, but you witnessed a pharmacist telling a 16-year-old girl that he wouldn’t fill her prescription for birth control pills because he thought she shouldn’t be having sex? Would you step in to tell the pharmacist he was wrong for imposing his moral beliefs on the girl, or would you commend him for urging her to practice abstinence?

The latter situation was probed on last night’s episode of the ABC News program What Would You Do?, where producers used the very real situation of pharmacist refusals as a backdrop for what the narrator called the show’s “hidden camera experiment on the touchy subject of teenage sex.”  ABC News’s “experiment” yielded interesting results – among the pharmacy customers who witnessed the actor refusing to dispense birth control pills to the 16-year-old actress, only half spoke up. Most customers thought that the pharmacist was wrong, but only one woman confronted him directly. Four customers agreed with the pharmacist, even when they were told he acted in violation of the store’s policy and that under New Jersey law, the girl should have left the pharmacy with her birth control pills in hand. 

Although, as ABC News pointed out, teen pregnancy is on the rise, refusing to provide teenagers with contraception is not the way to deal with teen sex. According to our friends at the Guttmacher Institute, nearly half of all teens aged 15 through 19 have had sex. Research shows that restricting minors’ access to contraception doesn’t dissuade them from having sex; it just increases the rate of teen pregnancy. All women, including teenagers, should have access to contraceptives.

Shedding Some Light on Midnight Regulations

by Jen Swedish, Health Law Fellow
National Women’s Law Center

Yesterday, I attended a congressional hearing entitled “Midnight Regulations: Shedding Some Light,” held by the Subcommittee on Commercial and Administrative Law of the House Judiciary Committee. The hearing examined both procedural and substantive concerns with a number of regulations that the Bush Administration pushed through in its final days, including the Department of Health and Human Services (HHS) regulation that we’ve blogged about before.

We here at the National Women’s Law Center are particularly concerned about the HHS regulation because it significantly limits patients’ access to health care and even to basic information about their health care options. And, we’re not the only ones who think there’s a problem – at yesterday’s hearing, Committee Chairman Cohen, Representative Jerrold Nadler, and Gary Bass of OMB Watch all pointed to the HHS rule as a troublesome regulation passed hurriedly in the waning hours of George W. Bush’s presidency. Indeed, when Dr. Bass was asked which of the midnight regulations was most egregious, he pointed to the HHS rule – and the fact that a key step in the rulemaking process was conducted in only a matter of hours as opposed to the weeks or months it normally takes.

We’re encouraged that Congress is considering how to respond to the troublesome midnight regulations enacted at the end of the Bush Administration, and we hope that President Obama and the newly-constituted HHS take action to correct this wrong. Raise your voice and let them know how dangerous this regulation is.

Arizona Again Considers Abortion Ban

by Jen Swedish, Health Law Fellow
National Women’s Law Center

Now that Janet Napolitano has left her position as Arizona’s governor to serve in President Obama’s Cabinet, anti-choice members of the Arizona State Legislature are wasting no time with a state copycat of the federal ban upheld in Gonzales v. Carhart. As my colleague Gretchen Borchelt has reported before, the federal ban prohibits a medically-approved abortion procedure without making an exception for women’s health. State copycat bans, like the one introduced in Arizona, often seek harsher penalties for doctors and more aggressive enforcement of the law.

Then-Governor Napolitano vetoed two state copycat bills during the 2008 session of the Arizona legislature, so it’s no surprise that anti-choice legislators are trying again now that she’s gone. And, there’s reason to believe this bill may move quickly – it was introduced in the Arizona House last Tuesday and unanimously approved by committee the very next day. The bill now goes to the full House, and its sponsors are confident that current Governor Jan Brewer, unlike her predecessor, would sign it if it passes the legislature. We’re paying close attention and will keep you posted.

Women Charged More for Health Insurance

by Ellen Newcomb, Program Assistant
and Jen Swedish, Law Fellow
National Women’s Law Center

This post is part of a weekly series on Women and Health Reform.

This morning’s New York Times article by Robert Pear highlights the challenges women face in the individual market as identified in our recent report, Nowhere to Turn: How the Individual Health Insurance Market Fails Women. In our report, we document the fact that women attempting to buy health insurance on the individual market often face higher premiums and fewer options for comprehensive and affordable coverage than their male counterparts. And in this economic and political climate, with employees facing layoffs and politicians emphasizing the use of the individual market as a “fix” to our health care crisis, this puts women in grave risk of not receiving the quality health care they need.

The NYT article explains the discrepancy in prices between men and women as actuarially justified, that is, as a result of women’s higher health care costs. In particular, health insurance companies point to women’s maternity care as a reason why prices for women are inflated. But, then why is it that out of the 347 gender-rated, best-selling individual market plans we looked at on eHealthinsurance.com, only 6% include maternity coverage? A senior VP at Humana argued that higher premiums are justified even if maternity coverage is excluded, because “Bearing children increases other health risks later in life, such as urinary incontinence, which may require treatment with medication or surgery.”  So, women should pay more for health insurance coverage because they might get pregnant and the pregnancy might cause urinary incontinence that might require surgery?  How absurd!

Some comments to the NYT article contend that it’s fair for women to pay more for health insurance because men routinely pay more for car insurance. We’re not saying gender rating for car insurance is fair, either. But according to recent research, 22,000 adults died in 2006 because they lacked health insurance. No one dies because they cannot buy car insurance.

We encourage you to visit our site to learn more about our report. You can also contact your Members of Congress to encourage them to stop allowing discriminatory practices in health insurance. It’s just like Rep. Xavier Becerra from California says, “'If men could have kids,' such disparities would probably not exist.”