OB/GYN ACCESS: States Step Up to the Plate

      In the absence of sweeping federal legislation, states have stepped forward to increase women's access to OB/GYNs and insurance coverage of contraceptives, and expanded Medicaid-based reproductive health services to the nation's 15 million uninsured women, according to a report released today by the Kaiser Family Foundation. Since 1995, 35 states and the District of Columbia have passed laws mandating that women enrolled in HMOs be provided with increased or direct access to OB/GYNs, and 12 of those states and the District of Columbia allow women to designate their OB/GYN as their primary care provider. Ten states require private insurers to cover all contraceptives, nine of which passed laws within the last year. Eleven states have obtained Medicaid waivers from HHS to expand family planning and reproductive health services to uninsured women (Kaiser release, 11/2). "The regulation of insurance has always been a state responsibility," said Diane Rowland, Kaiser Family Foundation executive vice president. She added that while it remained unlikely that stand-alone federal legislation mandating increased access to OB/GYNs would pass, "such a measure is part of the omnibus patients' rights bills" currently pending in Congress. A 1998 survey by the National Partnership for Women and Families in Washington, D.C., indicated that "women strongly supported direct access to the doctors." Judith Lichtman, the group's president, said, "Women have very different primary-care needs than men. Often, maybe always, those needs are best met by having direct access to OB/GYN services." But some OB/GYNs are hesitant to fulfill the role of a primary care provider, according to Richard Bondi, a board-certified OB/GYN who also serves as Northeast medical director for women's health at Aetna U.S. Healthcare. "They don't want to be treating broken bones or pneumonia," he said (Rubin, USA Today, 11/2).

Better Access, Better Care
      The Kaiser study indicates that women who regularly visit an OB/GYN are more likely to receive preventive health care services such as pelvic exams, Pap smears, HIV and STD testing and information on family planning. The report notes that women's out-of-pocket health expenses during childbearing years are about 68% more than men's, due in part to the increased expense of reproductive health services, including pregnancy care and contraception. Medicaid provides a full-range of contraceptive coverage, and 93% of HMOs and 81% of POS plans offer birth control coverage. The Kaiser report asserts that when "resources are limited, some women will forego birth control altogether or use a less expensive method that may not be most appropriate for them" (Kaiser release, 11/2). Lawmakers are considering federal legislation that would require all health plans that cover prescription drugs to cover contraceptives, but Kathryn Kolbert, a senior researcher at the University of Pennsylvania's Annenberg Public Policy Center, said the chances of such a law being enacted soon are "remote." She added, "Both as a public health matter and a matter of equity, women and their male partners ought to have a choice of the method they use. Where you live shouldn't determine the quality of care you receive" (USA Today, 11/2).