BILL ANALYSIS                                                                                                                                                                                                    



                                                          AB 39
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CONCURRENCE IN SENATE AMENDMENTS
AB 39 (Hertzberg)
As Amended September 2, 1999
Majority vote
  
ASSEMBLY: 52-26                 (April 19, 1999)                 
SENATE:   23-12                 (September 7, 1999)             
   
  Original Committee Reference:    HEALTH  
  
SUMMARY  :  Establishes the Women's Contraception Equity Act,  
which requires health care service plan contracts to cover  
prescription contraceptive methods.  Specifically,  this bill  : 

1)Requires specified group and individual health plan contracts  
  issued, amended, renewed, or delivered on or after January 1,  
  2000, that provide coverage for outpatient prescription drug  
  benefits to include coverage for a variety of federal Food and  
  Drug Administration (FDA) approved prescription contraceptive  
  methods.

2)Requires contraceptive benefits provided under the provisions  
  of this bill to be the same for an enrollee's covered spouse  
  and covered nonspouse dependents.

3)Exempts specialized health plan contracts from the  
  requirements of this bill.

4)Provides that a religious employer may request a health plan  
  contract without coverage for FDA-approved contraceptive  
  methods that are contrary to the religious employer's  
  religious tenets.  Provides that this provision shall not be  
  construed to deny an enrollee coverage of, and timely access  
  to, contraceptive methods.

5)Defines "religious employer" as an entity for which:

  a)   The inculcation of religious values is the purpose of the  
  entity;

  b)   The entity primarily employs persons who share the  
  religious tenets of the entity;

  c)   The entity serves primarily persons who share the  
  religious tenets of the entity; and,








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   d)   The entity is a nonprofit organization pursuant to  
     Section 6022(a)(2)(A)I or iii, of the Internal Revenue  
     Code.

6)Requires any organization that invokes the religious exemption  
  in this bill to provide written notice to prospective  
  enrollees, listing the contraceptive services the employer  
  refuses to cover.

7)Provides that nothing in this bill is to be construed to  
  exclude coverage for prescription contraceptive supplies  
  ordered by a health care provider for reasons other than  
  contraceptive purposes, such as decreasing the risk of ovarian  
  cancer or eliminating symptoms of menopause, or for  
  prescription contraception that is necessary to preserve the  
  life or health of an enrollee.

  The Senate amendments  insert the religious exemption and written  
notice provisions of this bill.

  EXISTING LAW  :

1)Requires health plan contracts to cover a core package of  
  benefits plus certain other mandated benefits.

2)Permits health facilities and health professionals to refuse  
  to participate in certain clinical procedures on moral  
  grounds.

  AS PASSED BY THE ASSEMBLY  , this bill established the Women's  
Contraception Equity Act, which requires health care service  
plan contracts to cover prescription contraceptive methods.

  FISCAL EFFECT  :  Negligible, according to the Assembly  
Appropriations Committee analysis.

  COMMENTS  :  This bill is intended to require health plans to  
cover FDA-approved contraceptive methods.  The author argues  
that this bill addresses the inequity in prescription benefits  
for women, since many plans do not provide routine coverage for  
birth control.  As a result, the author notes that women pay 63%  
more in out-of-pocket costs (i.e., mostly attributed to  
reproductive health expenses) than men.  The author argues that  
contraception should not be a luxury for women, that  








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contraceptives have been shown to lower the risk of ovarian  
cancer, and that reducing unintended pregnancies may lower  
employer costs.
  
  This bill is substantially similar to AB 160 and AB 1112, both  
authored by Assemblymember Hertzberg and vetoed last session.   
In his veto message for AB 160, Governor Wilson indicated a  
willingness to ". . . sign legislation if it exempts religious  
employers and organizations based on their religious beliefs  .  
. ." and highlighted his leadership in implementing the Family  
Planning Access, Care and Treatment program (Family PACT).   
Following this veto, Assemblymember Hertzberg introduced AB  
1112, a substantially similar measure that exempted religious  
organizations and permitted employees of such organizations who  
earn up to 400% of the federal poverty level to secure  
contraceptive coverage through the Family PACT program.  The AB  
1112 veto message stated that it is inappropriate for taxpayers  
to pay for contraceptives for certain employees that earn up to  
400% of the federal poverty level.  This bill requires health  
plans to provide contraceptive coverage, and SB 41 (Speier)  
contains a companion requirement for disability insurers.

This bill exempts churches, synagogues, mosques, temples,  
missions parochial schools, seminaries and convents from  
providing contraceptive coverage.  The Catholic Conference and  
the California Association of Catholic Hospitals (CACH) argue  
that this exemption does not go far enough, and desire to  
include organizations such as hospitals, universities, private,  
non-parochial schools, and social services agencies.  The  
sponsors, American College of Obstetricians and Gynecologists,  
District IX, and Planned Parenthood Affiliates of California,  
argue that an exemption for employers other than religious  
organizations would allow an employer to make family planning  
decisions for its employees.  As employers and health care  
providers, Catholic-affiliated hospitals provide health care  
services, and they employ thousands of employees in managerial  
and clinical positions that require no religious training,  
experience or belief.

  Analysis Prepared by  :  Ann Blackwood / HEALTH / (916) 319-2097
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