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Copyright 1999 The New York Times Company  
The New York Times

June 30, 1999, Wednesday, Late Edition - Final

SECTION: Section A; Page 1; Column 5; National Desk 

LENGTH: 1442 words

HEADLINE: Insurance for Viagra Spurs Coverage for Birth Control



Viagra, it turns out, has a political side effect.

Last year's anti-impotence sensation has led to this year's byproduct: Around the country, more than a half-dozen state legislatures, swayed largely by insurers' coverage of Viagra treatment, have recently passed measures requiring carriers that cover prescription drugs to pay for women's contraceptives as well. More states are expected to follow. Today New Hampshire's Legislature became the latest to send a "contraceptive equity" bill to the Governor, joining North Carolina, Vermont, Georgia, Connecticut, Maine, Hawaii and Nevada. In an additional half-dozen states, New York and California among them, contraception bills have passed at least one house in recent months, according to the National Conference of State Legislatures. Such measures have been introduced in more than 30 legislatures in all.

For decades, women's advocates had little success in pushing insurance coverage of contraceptives. But now that Viagra has been made available and quickly included in many insurance plans, they say, they have been able to add to their arsenal of arguments the tough-to-beat issue of basic fairness: if insurance can help a man enhance his sex life -- and at a pricey $10 or so a pill -- it ought to help a woman enable her own.

"That little blue pill gave the birth-control pill that's been around for 40 years great credibility as an issue, because it's so clearly juxtaposed," said State Senator Jackie Speier, who is sponsoring the contraception bill in California. Viagra made any argument against mandated contraception coverage "laughable, really," Senator Speier said. "No one can really argue it with a straight face anymore."

Most of the recent legislation requires coverage of birth-control pills, intrauetrine devices, diaphragms and the long-term hormonal treatments Norplant and Depo-Provera. Experts on women in politics say the speedy success of so many contraception bills reflects not only good timing but also the rising power of women in state legislatures. One result of that growing power has been greater attention than ever to women's health, with new laws on issues like breast cancer and "drive-through" baby deliveries.

On certain issues like contraception coverage, female legislators tend to join forces across party lines, rally their male counterparts on both sides of the aisle and become hard to stop, said Debbie Walsh, associate director of the Center for the American Woman and Politics at Rutgers University.

Men have acted as sponsors and supporters of many of the contraception bills, said Linda Tarr-Whelan, president of the Center for Policy Alternatives, a Washington group that has helped legislators push for the measures. But over all, she said, the wave of contraception bills amounts to "the most striking example in the legislative sessions that have just finished of the power of women's leadership."

Such power is considerably more pronounced in state legislatures, where women are now an average of 22.3 percent of the ranks, than in Congress, where they are only 12.1 percent and party lines tend to be harder for them to cross.

In the United States Senate, Olympia J. Snowe, Republican of Maine, championed a contraception coverage bill last year without success, although a measure requiring such coverage for all Federal employees did pass. Encouraged in part, a spokesman said, by progress at the state level, Senator Snowe introduced her bill again two weeks ago with Senator Harry Reid, Democrat of Nevada.

But even in states where women hold strong leadership positions, the going has often been far from easy for the contraception coverage bills. The Washington Legislature, for example, has a higher proportion of women, 40.8 percent, than any other state legislature in American history, and yet its contraception bill, which passed the Senate in March, remains pending in the House, hampered by questions about its cost.

In Georgia, where the contraception bill did pass, "we were in the bitterest of fights," said State Representative Nan Grogan Orrock, who sponsored the legislation. "The right wing," she said, "pales beside the business community," which opposed saddling employers with another insurance requirement.

Even in Maine, where the State Senate's president, a Democrat, and its minority leader, a Republican, joined forces to sponsor the bill, there was a tricky moment: after the measure sailed through both houses last month, Gov. Angus King, an independent, said the cost gave him some reservations about signing it.

Then, the widespread theory goes, he exchanged views with his wife, a former lobbyist for Planned Parenthood, said Jane A. Amero, the minority leader. The Governor expressed support for the bill the next day -- he has since signed it -- "and I think his wife had a lot to do with it," Senator Amero said.

In general, resistance to the bills has come from Roman Catholic groups that oppose birth control and have fought, with mixed success, for exemptions for religious institutions. There has also been some opposition from anti-abortion groups that see morning-after pills as virtual abortion drugs, and from business and insurance groups complaining of yet another state mandate.

Idaho's contraception bill foundered in committee, said a sponsor, Wendy Jaquet, Democratic leader in the Republican-controlled House of Representatives. "There's a lot of influence the insurance companies have in our Legislature," Representative Jaquet said, "and there's a real concern about raising premiums. And it's hard to get across the argument that this is really prevention, and if you have a baby the insurance companies pay more."

But in general, several successful sponsors elsewhere said, pointing to a Viagra parallel has helped dissipate much of the opposition.

A similar Viagra effect has been observed as far afield as Japan, the only industrialized country that bans birth-control pills. Japanese medical authorities have long kept the pills off limits, citing concerns about their safety. But earlier this month the country's top medical advisory council suddenly changed its mind and recommended lifting the ban, propelled in part, it seemed, by the uproar from women's groups that pointed to the speedy approval of Viagra as proof of discrimination against women.

In the United States, the statistic that coverage advocates most often cite is that women between the ages of 15 and 44 spend 68 percent more on out-of-pocket health costs than do men, much of it on contraception. (Among that age group of women, birth-control pills are the most commonly prescribed drug.) The advocates note that nearly half of all pregnancies in the United States are unintended and that although 93 percent of health maintenance organizations cover contraceptives, only about half of indemnity plans do so. A drop in unplanned pregnancies, they argue, would lead to a decrease in infant mortality.

For their part, opponents tend to denounce the addition of yet another mandate on insurers and yet a further cost for employers, estimated at $1.43 a month per employee. When the cost of insurance coverage rises, they argue, fewer employers and consumers buy it.

Americans, polls have shown, tend to favor requiring insurance companies to cover contraception. So do an array of medical organizations, including the American College of Obstetricians and Gynecologists. Maryland, ahead of the pack, enacted a contraception coverage bill in 1998, and several other states, including Texas and Minnesota, have similar though less sweeping regulations.

One interesting aspect of the new wave of contraception coverage bills is that Viagra, which counteracts impotence, is not an exact logical parallel to pills or devices that counteract conception. But it was close enough to be used that way by lawmakers who saw their moment and jumped at it, political analysts note.

Such shrewdness among women in politics seems to be growing, said Elizabeth A. Sherman, director of the Center for Women in Politics and Public Policy at the University of Massachusetts in Boston. Also at play, she and others said, is the growth of women's caucuses, research organizations and leadership groups that give them a strong position to push from when such a moment comes.

"So when an issue like this or drive-through delivery comes up, they already have a caucus and have respected women who have been in power and are ready," Ms. Sherman said. "It's the political infrastructure that makes it possible for women in power to drive these issues right to the top of the agenda."

LOAD-DATE: June 30, 1999

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