The Alan Guttmacher Institute

Major Developments in the States in 2004


Improving Access to Care

Contraceptive Coverage

Twenty-one states require insurance plans that cover prescription drugs to cover contraceptive drugs and supplies approved by the U.S. Food and Drug Administration. Twelve of these mandates permit employers or insurers to refuse to provide contraceptive coverage if doing so would be against their conscience; thus, a key challenge facing advocates of contraceptive coverage is to ensure that any exemptions are narrowly tailored to minimize the number of people denied coverage. This effort received a major boost in March when the California Supreme Court upheld a narrow provision that permits an employer to refuse to cover contraceptives only if it has as its mission the inculcation of religious values, primarily employs and serves people who share its religious tenets, and falls under a U.S. tax code provision that applies to churches, church auxiliaries and religious orders. The U.S. Supreme Court declined to hear an appeal.


Emergency Contraception

Maine enacted legislation permitting pharmacists to provide emergency contraceptives without a prescription. The measure requires the pharmacist to undergo training on emergency contraception and to provide the patient with a factsheet on the medication. This brings to six the number of states that give women the option of obtaining emergency contraceptives without a prescription.

[Last year was the first, however, in which legislatures moved to restrict their expansion programs. The measure adopted in Connecticut would limit the state's expansion to adults. Indiana 's would implicitly exclude coverage for emergency contraception, even though emergency contraception is covered for other Medicaid recipients. The Texas legislation is quite restrictive: It contains both of the above provisions, requires that contraceptive counseling emphasize sexual abstinence for unmarried women and bars participation in the program by any family planning provider that also provides abortion-related services with other funding.]


Impeding Access to Care

Comprehensive Abortion Bans

Two states enacted legislation aimed at significantly limiting abortion services:

  • Michigan enacted a measure that will limit abortions to cases where the woman's life is endangered; the law is to go into effect in March.  
  • A law enacted in Mississippi would require that abortions after the first trimester be performed in a hospital. However, since no hospital in the state provides procedures after the first trimester, the law effectively would ban second trimester abortions. Enforcement of the law is blocked pending the outcome of litigation.




Kentucky, Mississippi and Virginia enacted measures that allow a fetus to be considered a human being for purposes of the states' homicide statutes. (Similar measures were vetoed in Iowa and West Virginia.) This brings to 31 the number of states with similar laws.


'Partial Birth' Abortion

Utah enacted a measure amending its existing ban on 'partial-birth' abortions to no longer allow the procedure when the woman's health is endangered. The measure also broadened the ban so that it is potentially applicable to a wide range of abortion procedures. Enforcement of the measure is blocked pending the outcome of litigation. Thirty-one states ban \x93partial-birth\x94 abortions; four of these include an exception for the woman's health. (In 2003, President Bush signed a federal ban on the procedure. This measure has been declared unconstitutional by three federal district court judges, and enforcement of the law is blocked pending appeal.)


Refusal Clauses

In May, Mississippi enacted legislation described by the governor  as "the single most expansive" refusal law in the nation. The law permits individuals and institutions who provide or pay for health care to refuse to be involved in any service to which they object on moral, ethical or religious grounds, regardless of the impact of their decision. The law covers activities such as counseling, diagnosis and research, as well as dispensing or administering any type of drug, device, surgery, care or treatment. Individuals able to refuse include any employee of a hospital, clinic, nursing home, pharmacy or medical school, along with students, counselors or "any other person who furnishes, or assists in the furnishing of, a health care procedure." Similar legislation was vetoed in Wisconsin.


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