Editor's note: This blog post is coauthored by Rachel Benson Gold and Elizabeth Nash.
Rachel Benson Gold is the Guttmacher Institute's Director of Policy Analysis and Elizabeth Nash holds the position of Public Policy Associate. Both work in the Institute's Washington-based Public Policy Division.
Nothing is certain in life but death and taxes, and maybe the fact that the world of reproductive health can always be counted upon to generate plenty of excitement. For those of us who make a living following reproductive health issues at the state level, 2006 is no exception – with high-profile events like the referendum on South Dakota's abortion ban or the ballot initiatives on parental notification for abortion in California and Oregon only the tip of the iceberg.
So what all has been happening so far in 2006? By the beginning of October, just over 1,200 bills on topics related to sexual and reproductive health had been introduced in the 50 state legislatures-and 107 new laws had been enacted in 37 states.
But even as reproductive rights continue to come under attack in a number of states, state-level advocates and national organizations are working to protect and increase access to reproductive health care. As a result of their work we also have many positive developments to report. Among the most significant measures supportive of sexual and reproductive health and rights that have been enacted so far this year are provisions that:
- protect the right to choose abortion in Hawaii;
- continue Maryland's policy of funding abortion services for low-income women in cases of life endangerment, serious risk to the woman's mental or physical health, rape, incest or fetal abnormality;
- direct Virginia to apply for a federal waiver to extend Medicaid coverage for contraceptive services to individuals with incomes up to 133% of the federal poverty level;
- require health plans that cover prescription drugs to cover FDA-approved contraceptive methods in New Jersey;
- allow pharmacists to dispense emergency contraception without a physician's prescription in Vermont;
- require that the printed materials distributed as part of abortion counseling in Idaho be "nonmisleading" and medically accurate; and
- allow minors to consent to prenatal care in Colorado.
Unfortunately, there are plenty of instances where states have enacted measures that are hostile to sexual and reproductive health and rights. Among the most significant are provisions that:
- seek to ban abortion in South Dakota and Louisiana;
- require that women seeking an abortion in Oklahoma be given unscientific information about fetal pain;
- require that a parent not only be notified, but also give consent before a minor obtains an abortion in Oklahoma and Utah;
- exclude agencies that provide abortion-related services from participating in state-funded family planning programs in Michigan, Ohio and Pennsylvania; and
- consider the fetus an independent homicide victim when a pregnant woman is killed in Alabama, Alaska, Georgia, Nebraska, Oklahoma and South Carolina.
(For more information on state laws on reproductive health issues click here to see Guttmacher's state policy fact sheets.)
Among the many disparate developments in state legislatures, some interesting trends in insurance coverage for reproductive health services are emerging. Although only one state, New Jersey, has enacted a new law this year mandating private-sector insurance coverage of contraceptive services and supplies, a total of four states, in fact, have acted to guarantee such coverage.
Significantly, the three other states took administrative, rather than legislative, approaches to the issue. The Montana Attorney General, the Michigan Civil Rights Commission and the Wisconsin Department of Workforce Development all concluded that excluding contraceptives from health plans that cover other prescription drugs constitutes sex discrimination. To date, 26 states across the country have adopted a legislative or administrative policy mandating insurance coverage of contraceptive services and supplies (See Insurance Coverage of Contraceptives).
Also this year, New York's highest court upheld the provision in that state's mandate limiting the right to refuse to include contraceptive coverage only to bona fide religious employers – basically defined as those whose mission is to promote the doctrines of a specific faith and who primarily employ and serve people sharing that faith. The provision had been challenged by a coalition of religiously-affiliated organizations in the state as being too narrow. The new contraceptive coverage mandate in New Jersey also includes an exemption for religious employers, although the definition of that term is somewhat broader than in New York.
In other areas of sexual and reproductive health, two states that had already mandated coverage of pap tests expanded their requirement to other services related to cervical cancer. A newly adopted California measure adds a mandate for coverage of HPV testing, while West Virginia expanded its requirement to include newer forms of cervical cancer diagnosis, such as Thinprep®, as well as HPV testing. At the same time, however, the West Virginia measure restricts the benefits of the mandate, including the already-existing provision related to pap tests, to women 18 and older.
Bucking the trend to expand coverage, Rhode Island moved to curtail coverage of infertility services. The measure adopted this year requires infertility coverage only for married women aged 25-40 who are unable to conceive after two years. Under the previous mandate, coverage was required for married women, regardless of age, who had been unable to conceive for one year.
If you are interested in keeping up with sexual and reproductive health and rights developments in the states, please check the Guttmacher Institute's monthly state policy updates or subscribe to our State News Quarterly electronic newsletter.