AN OUNCE OF PREVENTION: NEW LAW WILL CHANGE WOMEN'S HEALTH COVERAGE IN MISSOURI

Women commonly cite a lack of time, meager health insurance policies and the high cost of care among the reasons they skip medical exams and health screenings.

But recently approved state legislation called the Women's Health Initiative should make it easier for women like Sharon Carners of Morley, Mo., to see the doctor of their choice for cancer screenings, contraceptives and other preventative health services without paying for the care out-of-pocket.

Carner, 36, a homemaker, said she hasn't always had health insurance and often put off seeking medical care because of the high costs. But even after becoming insured, she said she has paid for treatment of several health problems that might have been detected and treated for less if she'd had regular screenings.

"If we're not in pain, we don't go to the doctor," Carner said of women. "I think if there had been a lot of different, direct access to tests, I wouldn't have the problems I have."

Carner said she hopes the new legislation will convince women to seek regular treatment for gender-specific health problems like cervical and ovarian cancer.

Victory for women

The measure, HB 762, received strong bipartisan support in the General Assembly and was a top priority for Gov. Bob Holden during his first legislative session. Holden is expected to sign the bill into law this summer.

"Now women will not have to jump through hoops to get the health care services they deserve," Holden said in May after the bill passed.

The goals of the measure are to reduce the out-of-pocket expenses women pay for care and eliminate excessive restrictions imposed by insurance carriers that limit the number of times women can visit their obstetrician-gynecologist for treatment each year.

Current Missouri law allows insurers to cover costs for a single, annual visit to an ob-gyn without a primary care doctor's referral. The new measure will mean coverage for unlimited direct access "as long as women are going for nationally recognized treatments," said state Department of Insurance spokesman Randy McConnell.

"It's a tremendous waste of money to go see a doctor so you can go see another doctor," he said. "This would cover all the insured people who have either group, individual or HMO coverage."

McConnell said many insurers already provide coverage for at least some of the services specified in the legislation, and the impact on insurance premiums would likely be negligible. He noted that the insurance industry backed the bill.

The new law also:

* Requires health carriers to notify all enrollees, male and female, of covered cancer screenings at regular intervals, consistent with American Cancer Society guidelines.

* Requires coverage for the diagnosis, treatment and management of osteoporosis for people with a condition or medical history that doctors believe warrants the care.

* Requires health carriers that provide pharmaceutical coverage to include coverage for contraceptives, including those contraceptive drugs or devices prescribed for other diagnosed medical conditions. This coverage excludes drugs and devices that are intended to induce abortions.

* Requires carriers to provide coverage for mastectomies, prosthetic devices, or reconstructive surgery without imposing a time limit. Women previously had to meet time restrictions for requesting a prosthetic device or reconstructive surgery.

According to the Department of Insurance, about 2.9 million insured Missourians -- including about 1.5 million women -- will be affected by the measure once it becomes law. The department will be responsible for overseeing compliance by insurance providers that conduct business in the state.

Joy Beaird of Jackson, Mo., 21, a homemaker, said the legislation is a victory for women, whose health concerns historically have been downplayed or lost in the shuffle.

"Mostly, the men were what they focused on," Beaird said. "Now they're actually starting to pay more attention because it is a big deal and women are dying just as much as men from some of these diseases."

Local impact

Local health professionals are optimistic about the measure. They said the legislation's stress on preventative medicine and early detection, such as cancer screenings, should mean reduced long-term expenses for insurers.

"It's a highly cost-effective process because anytime you have early detection and prevention, you're better off in terms of total cost," said Dr. Michael Jessup, a Cape Girardeau obstetrician-gynecologist.

Karen Hendrickson, assistant administrator and chief nursing officer at Southeast Missouri Hospital in Cape Girardeau, said access to health care services for women has been a problem in the region. Expanded insurance coverage should alleviate that, she said.

"In Southeast Missouri, you find women putting off needed preventative health services, gambling that they will remain well," Hendrickson said. "We think this legislation will be helpful."

Steven Bjelich, chief executive officer and president at St. Francis Medical Center, said the measure likely won't result in a large increase in the demand for screenings at the hospital.

However, the number of previously underinsured and Medicaid patients likely will increase as a result of the improved insurance coverage, he said.

"Most of their care I would suspect will be provided by their primary physician," Bjelich said. "Hopefully it will enhance the quality of care for women in the region, and help them seek out preventative programs."

Jessup said many of his patients will see a savings under the new measure because costs for birth control pills and other devices will be covered under insurance plans, and patients can make appointments without worrying about having to pay for the office visits themselves.

However, the money saved is outshone by the law's real benefit.

"This is going to save them money," Jessup said, "but it's also going to save lives."