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. 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:
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:
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.
Medscape Ob/Gyn. 2003;8(2) © 2003 Medscape
Cite this: Policies of Importance to Women's Health Vary Considerably Among States - Medscape - Nov 12, 2003.