Vasectomy scrutinized in contraception, scope of practice campaigns


The Affordable Care Act's controversial contraceptive coverage mandate requires most private health plans to provide cost-free coverage of female contraception. Reproductive health advocates in many states are pressing for new laws that include vasectomy in those covered services.

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or for more information.

The Affordable Care Act's controversial contraceptive coverage mandate requires most private health plans to provide cost-free coverage of all FDA-approved methods of contraception used by women. Reproductive health advocates in many states are pressing for new laws that will survive with or without the ACA and, additionally, cover male methods of contraception.

Contraceptive coverage mandated by the ACA was challenged in the courts from the very start. These legal entanglements contributed to inconsistent implementation and enforcement of the law. What's more, by restricting the coverage mandate to women, many insurance companies are relieved of the responsibility to cover vasectomy, a voluntary sterilization procedure chosen annually by more than 500,000 Americans.

Read more from AACU: HHS nominee Dr. Price promises physician-friendly reforms

According to the Guttmacher Institute, an advocacy group focused on sexual and reproductive health, 28 states guarantee private insurance coverage for most FDA-approved methods of contraception, while four states (California, Illinois, Maryland, and Vermont) require that it be provided to the patient cost-free. In recent years, several states have stepped in to expand these mandates to include contraception methods used by men.

Legislators in Maryland and Vermont passed new laws in May 2016 that prohibit health plans from including co-pays or co-insurance for any contraceptive method, including voluntary sterilization for men. Two months later, Illinois Gov. Bruce Rauner (R) approved a less-sweeping bill that requires vasectomy coverage, but allows cost-sharing.

Next: More states propose requiring insurers to cover vasectomy



Proposals requiring insurers to cover vasectomy


Colorado (HB 1294)
Alaska (HB 25)
Illinois (New law)
Hawaii (HB 1573)
Maryland (New law)
Minnesota (SF 409)
Massachusetts (HB 948, SB 483)
New York (AB 1378, SB 3668)
Vermont (New law)
Oregon (HB 2232)

Colorado, Massachusetts, and New York lawmakers considered similar measures in 2016, but those campaigns ultimately collapsed. Undaunted, early in 2017, a member of the New York Assembly re-introduced the "Contraceptive Equity Act". According to the bill's sponsor, Assemblymember Kevin Cahill (D), the new law would build upon "existing state and federal law to promote gender equity.”

As reported by the Associated Press, the health insurance industry warns against mandating comprehensive cost-free coverage. A senior vice president of the New York Health Plan Association is quoted as saying, "At a time when we are looking to ensure affordability, we shouldn’t be looking to add new requirements and new costs that would be borne by all premium payers."

Insurers in four other states-Alaska, Hawaii, Minnesota, Oregon-are likewise lining up to oppose bills requiring that all plans sold in the state cover voluntary sterilization.

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The Oregon legislature is considering proposals that would not only mandate cost-free coverage of male sterilization, but also give nurse practitioners the authority to perform the procedure. For several years, lobbyists representing women's health clinics across the state pushed for the expansion of nurse practitioners' scope of practice to specifically permit vasectomy. Representative Rob Nosse (D) introduced a bill in January 2017 that amends the politically sensitive sterilization law to exempt vasectomy from the list of procedures that a nurse practitioner may not perform.

Supporters argue that a shortage of doctors has resulted in long wait times for the procedure.

The Oregon Urological Society objected to an earlier version of the bill in a letter to the legislature's health committee. An article discussing the matter in the Portland Business Journal quoted Eugene Fuchs, MD, a urologist at Oregon Health and Science University. “Fuchs said vasectomies should be performed by someone with surgical training, which nurse practitioners lack. He said doctors don't even start training for vasectomies until two years into their residencies,” the article said.

Read: Committee seeks to ban concurrent surgeries

Past attempts to grant nurse practitioners this authority have fallen short, in part because lawmakers never received a study showing nurse practitioners would be as safe as physicians. Equally important in this case were the efforts of urologists, as individuals, and collectively as a society of professionals, to explain the practical implications of the proposal.

Public regulatory actions that impact the urologic community must be carefully scrutinized by the physicians who specialize in the treatment of those conditions. Professional organizations, including the AACU, exist to alert and advise urologists when their unique voice will improve public policies. The AACU provides members with several opportunities to make their voices heard, including advocacy conferences such as the 12th Annual Urology Joint Advocacy Conference, scheduled for March 7-10, 2017, in Washington.

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