Policies of Importance to Women's Health Vary Considerably Among States

Gwen Mayes, JD, MMSc

Disclosures

November 11, 2003

It is often said that states are a laboratory for policy formation and the best place to test the legal waters for a new idea. State lawmakers, more than federal ones, sift through the myriad of health, safety, and welfare concerns that might apply to their citizens and enact laws for the public's protection and benefit.

With such a personalized approach to policy formation, it should be no surprise that important women's health policies have been enacted by states in a piecemeal fashion.

In their benchmark report, Women's Access to Care: A State-Level Analysis of Key Health Policies, the Kaiser Family Foundation and the National Women's Law Center have taken an in-depth look at more than 50 key state policies that shape women's access to healthcare.[1] From private insurance to public assistance, from reproductive rights to administration positions and budgetary constraints, the report provides state-by-state information on women's health policy using the broadest definition possible.

"There has been a lot of positive movement in women's health policies in some key areas," says Alina Salganicoff, PhD, Vice President and Director for Women's Health Policy at the Kaiser Family Foundation (personal communication, October 29, 2003). "Private insurance carriers, for example, have more screening mandates and even Medicaid has expanded services. But in other areas, reproductive rights being one, it's a mixed bag. On one hand, we've seen more access to emergency contraception, but at the same time we've also seen growing efforts to limit access to abortion."

Although the report is quick to point out the glaring variation in state laws, there are several areas in which policies are fairly uniform across the country. Among the report's key findings are the following:

  • The majority of states allow women to see an ob/gyn without a referral or as their primary care provider.

  • All states and the District of Columbia have chosen to participate in the federal program to expand Medicaid coverage for the treatment of breast and cervical cancer to low-income women.

  • About two thirds of states have addressed mental health parity in an attempt to increase access to mental health services.

  • Nearly all states have domestic violence antidiscrimination laws, most commonly for health insurance, but also for life, disability, and property/casualty.

  • Nearly three fourths of states and the District of Columbia have expanded Medicaid eligibility for pregnant women above the federal mandated coverage level.

But an even greater number of women's health policies are scattered among only a handful of states. These sporadic, but growing, initiatives provide a window into future policy development. "Policymakers considering new legislation can look at how other states around them are addressing a particular issue," says Salganicoff. "It's one of the best ways they can use the report."

Although presently in the minority, a few states have enacted the following women's health services:

  • Additional laws to prosecute acts of violence or intimidation against abortion clinic staff, patients, and facilities (15 states and the District of Columbia)

  • Mandated coverage of colorectal cancer screening (14 states)

  • Mandated coverage of some type of infertility treatment (15 states)

  • Dispensing emergency contraception without a prescription (4 states)

  • Some form of osteoporosis screening coverage mandate (11 states); and

  • Creation of an Office of Women's Health by legislation, executive order, or administrative action (13 states).

One growing concern that threatens advancements in any area of women's access to care is lack of funding. "With budgetary problems, like the ones states are experiencing now, you're going to see cutbacks in eligibility for public services, increases in copayments, and fewer services," says Salganicoff. "Because women and children are more likely to rely upon public services, these cuts may disproportionately impact their access to services. As the dollars get tighter, women's services are likely to erode."

Ultimately one hopes that improvements in access to women's health services will lead to improvements in women's health status, but this is something even policy makers vigilantly watching these issues are reluctant to confirm.

Copies of the report are available at the Web sites of both the Kaiser Family Foundation (www.kff.org) and the National Women's Law Center (www.nwlc.org).

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