Not many people seem to have noticed yet, but buried among the new measures signed into law last week as part of Gov. Jim Doyle's budget is a trio of family planning initiatives that are expected to expand access to birth control and contraceptive education in Wisconsin.

Advocates who had fought for previous versions of the controversial measures over the past years, only to see them get beat back repeatedly by the Republican-controlled Legislature, are thrilled at the relative ease with which the measures passed this year -- thanks to the new Democratic majority. "Elections really do make a difference!" says Nicole Safar, a legal and policy analyst with Planned Parenthood Advocates of Wisconsin.

Opponents, of course, are furious. They criticize not just the new laws themselves, but what they see as the sneaky way in which Democratic lawmakers let the measures sail through the budget process and be signed into law, with little or no debate. (Never mind that in the past Republican politicians have done the same thing.) "These are not fiscal matters," says Matt Sande, legislative director for Pro-Life Wisconsin, which opposes all forms of birth control. "These are pure policy items that represent sweeping social changes. The public deserves a chance to debate them in the light of the day. This is not the way laws should be made. This is power politics at its worst."

Here, in the light of the day, is a summary of what the three new family planning laws will do, along with a mini version of the debate that reportedly never happened, at least not this year.

Pharmacy Mandate -- All pharmacies in Wisconsin will now be required to dispense prescribed contraceptives "without delay." Violators would face up to $2,500 in fines. In the past, some pharmacists in the state have refused to fill birth control prescriptions, claiming that their moral or religious beliefs do not permit them to do so. In 2008, a state appeals court upheld the state's Pharmacy Examining Board's rebuke of a pharmacist who refused to provide birth control pills to a customer. The Board ruled that while the pharmacist had the right to refuse to provide the pills himself, he was wrong to refuse to transfer her prescription to another pharmacy. Last year, after years of effort, Democratic lawmakers successfully pushed through a mandate requiring hospitals to provide emergency contraceptives to rape victims. The pharmacy mandate will increase birth control access for many more women.

Pro: Safar says Planned Parenthood and other activists have been fighting for this law since 1997. The version finally passed in last week's budget is what Safar calls a "compromise," because it requires pharmacies, not pharmacists, to fill the prescriptions. Pharmacies will need to make sure that at least one employee on duty is willing and able to dispense contraceptives. Safar says this shift in language and law was a calculated effort by backers, including Planned Parenthood and the ACLU, to sidestep the litigation that has resulted from similar laws in the states of Washington and neighboring Illinois. "What is most important is to ensure that women have access to a basic health need -- birth control," Safar says. "This bill meets that same end but is just a little softer."

Con: Not true, says Sande, who complains the bill is still a rock-hard "assault on conscience rights." Critics claim it violates both state and federal constitutional guarantees of an individual's right to conscientious objection and religious expression. So will there still be a lawsuit challenging the law? "Absolutely," Sande says. "These measures ought to be legally challenged. We will be looking for a pharmacist to be a plaintiff."

Contraceptive Coverage -- Health insurance plans that cover prescription drugs must now include birth control in that coverage. Around one-fifth of Wisconsin's most popular insurance plans with prescription drug coverage have excluded contraceptives from their benefits, according to a 2001 study done by the state Office of the Insurance Commissioner. Half of the country's states have enacted similar mandates, according to the National Conference of State Legislators.

Pro: More than 90 percent of women in the United States use some form of birth control at some point in their lives. The typical American woman wants two children and spends about five years pregnant, recovering from pregnancy, or trying to become pregnant -- and three decades trying to avoid pregnancy, according to the Guttmacher Institute. About half of all pregnancies in the United States -- around 3 million a year -- are unintended. Supporters point to these statistics and argue that birth control is a basic need for women, whose average health care costs are much greater than men's because of the costs of birth control and pregnancies. They also have argued that excluding birth control from otherwise comprehensive prescription drug coverage is a form of sexual discrimination. "It's an issue of fairness," Safar says.

Con: Critics retort that the use of birth control is actually an issue of personal choice or "convenience." It is not medically necessary or required to treat an illness or disease. What's unfair, they say, is to force insurers -- and ultimately members of the public -- to fund this personal decision. Some critics charge that in fact birth control pills cause "chemically induced" abortions. Sande complains the new law also raises thorny questions for various employers who may have chosen in the past not to provide health care with contraceptive coverage. "What will the Catholic Archdioceses do now?" he asks.

Expansion of public Family Planning program -- The state's BadgerCare Plus family planning Medicaid waiver program, which currently covers around 46,600 low-income women between the ages of 15 and 44, will now be expanded to include men.

Pro: Supporters say the program saves the state money, a huge plus given the record $6.6 billion deficit Doyle is wrestling with, and reduces the spread of sexually transmitted diseases. A 2008 state evaluation found that since 2003 the family planning program has saved the state $487 million, mostly by helping low-income women avoid unwanted pregnancies. The state's Department of Health Services estimates that in two years the new program will serve 2,870 men, and that providing them with birth control methods and information will result in 373 "averted births." According to the DHS, that means the state would save $5,501 in Medicaid costs for each of these avoided births or $2.05 million altogether.

Con: Critics of the new law call these promised savings pie in the sky, and indeed a report issued in May by the Legislative Fiscal Bureau found the DHS's projections "difficult to confirm," noting that the eight states that have also expanded family planning programs to men have not yet documented such savings. Conservative and religious critics warn the program will undermine parental authority and encourage teenage sex. Sande says that "at the least" his organization intends to lobby for a change to the new law that would raise the age at which young men can receive services to 18. He claims that nearly a dozen other states have won similar modifications. "This is a parental rights issue," he says. "We see this as a sexualization of our young teen children without any parental control."

Shawn Doherty - 7/06/2009 6:51 am

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