McCain's Viagra Moment

Summary
Planned Parenthood is running a TV ad showing John McCain painfully groping for an answer to a reporter's question: "It's unfair that health insurance companies cover Viagra but not birth control. Do you have an opinion on that?"

McCain had good reason to be flustered. The premise of the reporter's question is a myth. We couldn't find any data that show a disparity between health insurance companies that cover Viagra and those that cover birth control. The full range of contraceptives, in fact, are covered by more than 86 percent of private insurance plans written for employers.

Analysis
Early in July, a reporter on the McCain campaign bus said that "health insurance companies cover Viagra but not birth control" and asked for McCain's opinion on that. McCain responded with an extremely long pause, finally saying, "I don't know enough about it to give you a [sic] informed answer." Planned Parenthood has seized on that flop-sweat moment in a new ad portraying McCain as uninformed on reproductive rights. The ad is running in Washington, D.C., and in battleground states including Colorado, Iowa, Minnesota, New Mexico, Ohio and Wisconsin.

Planned Parenthood Ad: "Simple Question"
Narrator: Ever use birth control? Then you'll want to hear this.

Reporter: It's unfair that health insurance companies cover Viagra but not birth control. Do you have an opinion on that?

McCain: I don't know enough about it to give you a [sic] informed answer.

Narrator: Planned Parenthood Action Fund is responsible for the content of this advertising because women deserve quality health care.

Sexist Health Care?
The ad implies there is a significant disparity between the number of insurance plans that cover Viagra and those that cover birth control. But that's not the case. A 2004 report by the nonpartisan Guttmacher Institute found that in 2002, 86 percent of the plans that insurance companies typically wrote for employers covered the full range of approved reversible contraceptive methods (birth control pills, hormone injections, implants, IUDs and diaphragms), and only 2 percent covered no methods at all.

The worry that Viagra, but not birth control, is being included in health care plans is out-of-date, according to Adam Sonfield, who coauthored the report. He says that when Viagra initially became available and insurers began to cover it, "there was concern that this was the case and that insurance companies really were covering erectile dysfunction drugs but were not covering contraception." This concern, he says, helped spur efforts to get contraception coverage mandated in 27 states, and contraceptive coverage rates shot up as a result. Sonfield's study, which asked insurance companies about employer-sponsored plans, found that coverage of contraceptive methods had tripled from 1993 to 2002. Sonfield says that the number of plans covering birth control likely has continued to increase over the last six years, though he stresses that U.S. health care is still short of complete coverage.

There probably are, however, some insurers who do cover erectile dysfunction drugs and don't cover contraception, Sonfield told us. Guttmacher estimates that about half of all Americans with employer-provided coverage work for employers that self-insure, paying their employees' medical claims out of pocket. And it is certainly a fact that some of these employers have, at least in the past, paid for Viagra but not birth control. For instance, in 2005 Union Pacific Railroad, a self-insuring company, was sued because it covered erectile dysfunction drugs but not contraceptives. A 2007 appellate court decision ruled that the company did not have to provide birth control coverage, but by that time it had begun to offer coverage under the terms of an earlier court decision. Other companies may still cover Viagra but not birth control, although in 2000 the Equal Employment Opportunity Commissionruled that plans of this sort violate the Pregnancy Discrimination Act, an amendment to Title VII of the Civil Rights Act of 1964. Title VII applies to employers with 15 or more employees, employment agencies, labor organizations, and state and local governments.

As for Viagra, independent studies of coverage are sparse, but the ones that exist don't show that the drug is covered more than birth control. In 2000, an article in Health Affairs reported that "[o]nly about half of all U.S. health plans reimburse members for at least some Viagra pills." A 1999 Washington Post article reported that the drug company Pfizer, which makes Viagra, estimated the coverage rate at 40 percent. And a 2007 Mercer survey of large employers (500 or more employees) showed that about 30 percent denied coverage of erectile dysfunction drugs, and most of the remaining employers imposed limitations on coverage. A Pfizer representative had no comment when we requested more up-to-date information.

Still a Concern?
Certainly, the data on both Viagra and birth control coverage is incomplete. But while it may be accurate to claim that there exist insurers who cover erectile dysfunction drugs and not birth control, it is not accurate to imply that this disparity is common. The reporter's question was out of date at best. Planned Parenthood, a major advocate for reproductive rights, should know this.

When we asked Planned Parenthood whether insurance companies were denying coverage for contraceptives, the group pointed us to the text of a 2003 amendment introduced by Sen. Patty Murray (D-Wash.), which would have prevented insurance companies from denying such coverage. The text of the amendment includes the claim that "half of traditional indemnity plans and preferred provider organizations, 20 percent of point-of-service networks, and 7 percent of health maintenance organizations cover no contraceptive methods other than sterilization." This could be referring to a 1993 Guttmacher study showing that 49 percent of indemnity plans did not cover contraceptives, and that less than 20 percent of large-group indemnity plans and PPOs and less than 40 percent of point-of-service plans and HMOs covered the full range of reversible contraception options. By the time the Murray amendment was written, that information was 10 years out of date. Now, it's 15 years old and irrelevant, given Guttmacher's more recent findings.